Membership Form Date: *Membership Type: Valid Membership Type Must be Selected (required) Annual Regular Adult $30.00 + $1.50 online processing Annual Regular Adult plus WIN $40.00 + $1.50 online processing WIN (Women in NAACP, Add to Current Membership) $10.00 Silver Life (1 of 10 Installments) $100.00 + $2.00 online processing per installment Silver Life (Full) $1000.00 Golden Life (1 of 10 Installments) $200.00 + $2.00 online processing installment Golden Life (Full) $2000.00 Diamond Life (1 of 10 Installments) $300.00 per installment Diamond Life (Full) $3000.00 Premier Life (1 of 10 Installments) $500.00 per installment Premier Life (Full) $5000.00 Num of Installment Payments You Wish to Make *Name: *Address: *City/State/Zip: Unit: Contact: *Email: Registered To Vote: No Report Yes No Form : Validate Application by Clicking this Button Show or Pay For Validated Applications Invoice Info Do Not Use Browser Back Arrow Function, Close Tab To Cancel Inv # Invoice Total Description To Remove Invoice Item, Check Box on line and Click CK Membership Type or Item Name Quanity Price Total date fname middlei lname address apt_suite city state zip unit membership phone email voter dateofbirth installmentCt formValidated appCode appType appPrice appInvoice appOption Thank You! Stafford NAACP Invoice of Validated Membership Application Prepare Another Application
