Northern Virginia Section of the National Council of Negro Women Annual Membership Enrollment Form

Join now and become part of the legacy! Please Print Clearly Date: Salutation (Ms. Miss, Mrs., Mr.): First Name: Middle:

Last Name:

Mailing Address: City: E-mail: Telephone: Status: ☐ New Member

State:

Zip:

Cell: ☐Renewing Member Member ID (renewing members only):

Special skills: Committees: (Please select one or more) ☐Audit ☐Bethune ☐Bylaws

☐Cheerios ☐Education ☐Fashion Show

☐Finance ☐Health ☐Hospitality

☐Legislative ☐Membership ☐Nominating

☐Outreach ☐Programs ☐Publicity

☐Technology ☐Ways & Means ☐Youth

Select your membership category: Women: ☐Annual $40 ☐ Life $500 ☐ Legacy Life $1000 Men: ☐Associate $40 ☐ Associate Life $500 ☐ Youth $2 ☐ Student $10 ☐ Partner: $50 ☐ Advocate/Sponsor $75 ☐ Leadership Circle $150 ☐ Group Life $750 Make your check payable to NoVA NCNW (SAV003). Please mail the completed form with payment to NoVA Section SAV003 NCNW, P. O. Box 119, Merrifield, VA 22116. Total Payment:

Check Number:

Signature: How did you hear about NoVA Section? ___________________________________________________ NoVA Section of NCNW is a 501(c) (3) organization. For more information send email to [email protected] or visit our website www.novancnw.org.

Welcome!

Welcome! -

☐Youth. Select your membership category: Women: ☐Annual $40 ☐ Life $500 ☐ Legacy Life $1000. Men: ☐Associate $40 ☐ Associate Life $500. ☐ Youth $2.

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