National Association for the Advancement of Colored People at Case Western Reserve University

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This is a membership signup for the NAACP at Case Western Reserve University.

The inauguration ceremony for our chapter will occur during February as a part of the Black History Month Celebrations. We look forward to seeing you there and appreciate your commitment to serving our community.

If you have any additional questions, please contact:

George Bukenya; gxb258@case.edu

Nachiket Rajinikanth; nxr395@case.edu

Mrs. Janice Eatman Williams; jae@case.edu

Email *

Name *

Physical Mailing Address w/ Zip Code (Used by National Chapter) *

Affiliation with CWRU?
*

Undergraduate Student

Graduate Student

Staff/Faculty

Alumni

NAACP Membership Fee (Funds will be used for NAACP projects both nationally and locally)

If the option of online payment is chosen then details will be sent out soon to your emails.

If the option of cash is chosen, please mark on a sealed envelope and deliver to Mrs. Janice Eatman Williams at the Nursing Research Building office is 204 - C.

$10 Cash (Student Cost)

$15 Cash (Student Cost w/ National Chapter's Magazine)

$10 Online Payment (Student Cost)

$15 Online Payment (Student Cost w/ National Chapter's Magazine)

$30 Cash (Adult Cost)

$30 Online Payment (Adult Cost w/ National Chapter's Magazine)

Is there anything else you would like to comment on/share? Any additional questions you may have?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Case Western Reserve University. Report Abuse

Forms