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The Village Demands Statewide Coalition on Black American Affairs
Official Individual Membership Application
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First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Organization/Institution
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Your answer
Job Title & Classification (e.g., Faculty, Classified Professional, Trustee, Administrator, Student)
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Your answer
What type of annual membership are you purchasing?
Individual ($75)
Institutional ($500)
Individual Student ($25)
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Are you interested in joining one of the task forces?
Yes
No
Maybe
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If you answered yes or maybe to the previous question, which task force are you interested in joining?
Advocacy & Action
Education Action
Statewide Equity Institute
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Is there anything else you'd like to tell us?
Your answer
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