NAACP Portland Branch
Membership Application or Renewing Membership - Please print and mail to the address below. Thank you!
Date:________________________ 

Mr./Mrs./Ms. ______________________________________________________________

Street Address: ___________________________________________________________

City: _________________________________  State: _________  Zip: ___________

Phones: Home [night]___________________ Day [work]___________________

	Cell______________________

E-Mail: _______________________________________

Current Membership No. (if renewal): ________


Regular Annual Membership   

Regular Adult,       $30.00 ____

Youth with Crises,   $15.00 ____

Youth w/out Crises,  $10.00 ____

Annual Corporate, $5,000.00 ____
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Lifetime Membership

Junior Life - (date of birth) ___________________       $100.00 _____ 

Bronze Life - (date of birth) ___________________       $400.00 _____ 

Silver Life - (date of birth) ___________________       $750.00 _____ 

Gold Life - (date of birth) ___________________       $1,500.00 _____ 

Diamond Life - (date of birth) ___________________    $2,500.00 _____ 


Please make checks or money order payable to NAACP Portland; expect to hear from us within 30 days.

Mailing address: NAACP, P.O. Box 3631, Portland, ME 04104
Telephone: (207) 253-5074 and 1-866-252-5074
Fax: (207) 253-5079
e-mail: naacpportland@hotmail.com

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