Membership Form

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The form below must be printed out and mailed into our offices.  Highlight the form from the top bar to the bottom, and cut and paste into your word processor for best results.  Otherwise simply print the entire page by clicking print on your browser's print icon or menu.

FORT LAUDERDALE BRANCH - NAACP
MEMBERSHIP FORM

(You will receive membership materials and membership card in 4-8 weeks)

Please Print
Date:___________________  
Mr./Mrs.Ms:____________________________________________  
Street Address:__________________________________________  
City: ________________________________________ State: _____________ Zip:___________
Branch Affiliation ______________________________________
Current Membership No. (if renewal)____________
REGULAR ANNUAL MEMBERSHIP
LIFETIME MEMBERSHIP
Regular Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40 [ ] Junior Life-(date of birth___________) . . . . . . . . . . . $100 [ ]
Youth with Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $15 [ ] Bronze Life-(date of birth__________) . . . . . . . . . . . $400 [ ]
Youth without Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . $10 [ ] Silver Life . . . . . . . . . . . . . . . . . . . . . . . . .  $750 [ ]
Annual Corporate . . . . . . . . . . . . . . . . . . . . . . . . . $5,000  [ ] Gold Life . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 [ ]
  Diamond Life . . . . . . . . . . . . . . . . . . . . . . $2,500 [ ]

PAYMENT OPTIONS
Check or Money Order
Check Number:
Amount:___________________ ___
Credit Card
Credit Card Type:       Visa [  ]       MasterCard [   ]       American Express [  ]       Discover [  ]
Credit Card Account Number:____________________________________________________
Expiration:  ____/____
Signature:___________________________________________________________________
MAILING INFORMATION
PLEASE MAKE CHECKS PAYABLE TO NAACP
Thank you for your support.
Membership
Fort Lauderdale NAACP
1409 Sistrunk Boulevard
Fort Lauderdale, FL 33311
Please save a copy of this completed form as your receipt.

OR CALL:

954-764-7604 and ask for the Membership Department

We accept all major credit cards

                                                                                                               

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