NAACP Newburgh Highland Falls #2162 Membership Form
Membership confirmation .  Thank you for beginning the process to become active for social justice.  Please fill out all parts of this form.  After you submit , Please return to the website and pay the level of membership you selected using Paypal.  Appreciated is paying the processing (~2.9%)---This allows us to keep the website free.
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Email *
1.   Membership Information *
2.  Date *
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3.  First Name *
4.  Middle Initial
5.  Last Name *
6.   Street Address *
7.  Apt./Suite
Please supply if your delivery is made easier.
8.   City, State. (ex. Highland Falls, NY) *
Zip Code *
9.   10 Digit Phone No.   Example: XXX-XXX-XXXX *
Please include
10.  Are you a registered voter? *
11.   Membership Type (Please check one) *
Please be sure to pay the amount that matches your level when you return to the website.  *$6.00 per year of the membership fee will be applied toward your subscription to THE CRISIS (magazine) -----Thank you!
How many total years have you been a member of the NAACP?
Please give your best estimate including youth memberships you may have had.  
For Your annual Membership to be active,  you must pay by clicking on the link below:

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A copy of your responses will be emailed to the address you provided.
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