NAACP Easton Branch Membership Registration
Membership is the life-blood of the NAACP.  We depend on our memberships' generosity to insure the NAACP's independence.  We depend of you to keep the flames of freedom burning bright!

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Title
If "other," please indicate in the notes section at the end of the form.
Last Name *
First Name *
Email Address
If applicable
Street Address *
Please include apt./suite if applicable.
City *
State *
Zip Code *
Phone Number
Type of application *
Are you a registered voter? *
Current Membership #
If applicable.
Solicitor's Name
If applicable.
Campaign
If applicable
Membership Type
Select membership type -- one application per person.  For Junior Life & Bronze Life memberships, please indicate Date of Birth in the "Additional Information" section below.    
Select One
Regular Adult (Ages 21 & older) - $30 *
Youth with Crisis Magazine (Ages 20 & Under) $15 *
Youth without Crisis Magazine (Ages 17 & Under) - $10 *
Annual Corporate - $5,000 *
Junior Life (Ages 13 & Under) - $100 **
Bronze Life (Ages 14 - 20) - $400**
Silver Life - $750 **
Gold Life - $1,500 **
Diamond Life - $2,500 **
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Membership Notes
* Includes a 1-year subscription to THE CRISIS Magazine
** Fully-paid Life Memberships include a 10-year subscription to THE CRISIS Magazine

ANNUAL PAYMENT OPTIONS
Junior Life - Payable in annual installments of $25.00 or more
Bronze Life - Payable in annual installments of $50.00 or more
Silver Life - Payable in annual installments of $75.00 or more
Gold  Life - Payable in installments of $150 or more (only available to Silver or Regular Life Members)
Diamond Life - Payable in annual installments of $250 or more (only available to Gold or Golden Heritage Life Members)

$6.00 per year of the membership fee will be applied toward your subscription to THE CRISIS Magazine
Additional Information
If applicable.
Payment Information
ONCE YOU HAVE SUBMITTED YOUR MEMBERSHIP APPLICATION, YOU WILL BE DIRECTED TO A LINK TO PAY YOUR MEMBERSHIP FEE THROUGH PAYPAL.  PLEASE ENSURE THAT BOTH THE FORM AND PAYMENT HAVE BEEN SUBMITTED AS BOTH ARE NEEDED TO PROCESS MEMBERSHIP.  NOTE:  MEMBERSHIP FEES ARE NOT TAX-DEDUCTIBLE.
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