Membership Application Membership is the life-blood of the NAACP. We depend on our members’ generosity to insure the NAACP’s independence. We depend on you to keep the flames of freedom burning bright! New applicants and existing members complete the form below. Membership Application Date * Solicitor's Name Unit Number/Name Do you wish to affiliate with your local unit? Yes No Campaign Salutation Mr. Mrs. Ms. Miss Other Other: First Name * M.I Last Name * Phone # * Email Address * Are You a Registered Voter? Yes No Membership Type New Member Renewal Membership Gift Membership If renewal, member ID# Membership Class Regular Adult (Ages 21 and older) - $30 annually Youth with Crisis Magazine (Ages 20 and under) - $15 annually Youth without Crisis Magazine (Ages 17 and under) - $10 annually Annual Corporate - $5,000 annually WIN (Women In The NAACP) for CURRENTLY ACTIVE MEMBERS ONLY - $10 annually Junior Life (Ages 13 and under) - $100 one time Junior Life (Ages 13 and under) - $25 (4 installments) Bronze Life (Ages 14-20) - $400 one time Bronze Life (Ages 14-20) - $50 (8 installments) Silver Life - $750 one time Silver Life - $75 (10 installments) Gold Life - $1,500 one time Gold Life - $150 (10 installments) Diamond Life - $2,500 one time Diamond Life - $250 (10 installments) Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Payment Option * Online Mail payment Credit Card Important Tax Information Membership Type Full Payment Affiliated Tax Deductible Amount At-Large Tax Deductible Amount Subscribing Payment Affiliated Tax Deductible Amount At-Large Tax Deductible Amount Regular Adult $30.00 $11.85 $24.00 n/a n/a n/a Youth w/ Crisis $15.00 $10.20 $9.00 n/a n/a n/a Youth w/o Crisis $10.00 $5.70 $10.00 n/a n/a n/a Annual Coporate $5,000.00 $2,994.00 $4,994.00 n/a n/a n/a Junior Life $100.00 $54.00 $94.00 $25.00 $9.00 $19.00 Bronze Life $400.00 $234.00 $394.00 $50.00 $24.00 $44.00 Silver Life $750.00 $390.00 $690.00 $75.00 $39.00 $69.00 Gold Life $1,500.00 $840.00 $1,440.00 $150.00 $84.00 $144.00 Diamond Life $2,500.00 $1,44.00 $2,440.00 $250.00 $144.00 $244.00 CAPTCHA If you are human, leave this field blank. Submit