The Association for the Study of African American Life and History - Richmond, Virginia Branch Online 2022 Application
2022 Richmond Application
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Email *
Referred By
Prefix
First Name *
Middle Initial
Last Name *
Address
City
State
Zip
Phone Number *
Additional Email address
Birthdate *
MM
/
DD
/
YYYY
Membership Type *
For Institutional Members Only
 Enter the name of the Institution, College/University - (Department), Non-Profit Organization, Church/Religious Organization, or Student Organization.
For Dual Memberships Only
[Two persons in the same household may become dual members. Both may include their email address in the top section of this form to receive email correspondence. Both will receive discount privileges. The individual listed in the top section of this form will receive the publications, other mail and a ballot.]
For Dual Membership Only: Name of other member in the same household.
Student Membership Only
What is the name of your School/University?
What is your job industry (career)?
Committee Interest *
Required
How did you hear about ASALH Richmond?
Why are in interested in ASALH Richmond? *
Almost Complete
Your application is almost complete. Your application will not be complete until your payment is made. Once you click submit you will be able to pay using the link provided. Please click the link to take you to a secure portal to make your payment. You will also be asked to verify your application information. Thank you for your membership application to ASALH Richmond. We are excited you are here.



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