NAACP Membership Form (Wilkes-Barre #2306)

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

The Wilkes-Barre #2306 Chapter is Luzerne County's NAACP Branch. We serve the Cities and Towns in the County and are always expanding our DIVERSE membership to better suit the needs of the community.

Help be part of the solution, Join today.

Email *

Membership Campaign

Title

Mr.

Mrs.

Ms.

Miss

Other:

Clear selection

Date *

YYYY

First Name *

Middle Initial *

Last Name *

Email Address *

Address (Number and Street) *

City *

State *

Apt/Suite

Zip Code *

Membership Status *

New Member

Renewal

Phone Number *

Are you a Registered Voter?

Yes

Clear selection

Solicitor's Name

Member Number (For existing Members, located on Membership Card)

Membership Types Explained

Select Membership Type

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 - payable in annual installments of $25 or more)............ $100

Bronze Lifetime (Ages 14 - 20 - Payable in annual installments of $50 or more).......... $400

Silver Life (Payable in annual installments of $75 or more)........................................... $750

Gold Life (Payable in Installments of $150, only Available to Regular or Silver Mem)... $1,500

Diamond Life (Payable in Installments of $250, only Available to Gold Members)........ $2,500

Clear selection

Payment Options (Credit Card)

You can Pay by Credit Card Online at: www.NAACP.org
Additional Information: Branch (NAACP WB #2306)

Payment Options (Online)

You can Pay Online using Eventbrite, please buy the ticket that corresponds to your Membership Level:
- https://www.eventbrite.com/e/2023-membership-payment-tickets-525944402867

Payment Option (Check)

A check can be sent to:

NAACP WB Branch #2306
P.O. Box 2460
Wilkes Barre PA, 18703

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms