EmailMe Form - NC NAACP Branch Assessments

Branch Name *

Branch Unit Number *

Branch President's Name *

Branch President's Email *

Branch Treasurer's Name *

Branch Treasurer's Email *

Branch Secretary's Name *

Branch Secretary's Email *

Branch Treasurer's Phone *

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Branch Secretary's Phone *

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Branch Mailing Address *

Street Address City State / Province / Region Postal / Zip Code

Branch Phone

### - ### - ####

Humanitarian Assessment

50- 500 Members $250

501- 1000 Members $300

Mother of the Year Assessment

50- 500 Members $1000

501- 1000 Members $1500

Pay additional amount

$ Dollars . Cents

Please indicate reason for this allocation in the notes section

Payment Method *

Check (1 check per branch)

Pay Online with Credit Card or PayPal

Remit payment to: NC NAACP State Conference, PO Box 7186, Greensboro, NC 27417-0186

Notes