NJBIC MEMBERSHIP APPLICATION

Link to download membership form is at the bottom of this page.

Download the new jersey black issues convention organization membership application pdf

New JERSEY BLACK ISSUE CONVENTION MEMBERSHIP

Note: All online orders require the membership fee to be paid via credit card.

If you choose to download and print your application it MUST be accompanied with a check or money order in the amount of $150.00 made payable to the New Jersey Black Issues Convention (NJBIC) in order to be considered for membership in NJBIC.

Organization Contact Information

Name
Address
Please enter a valid phone number.
Please enter a valid phone number.
example@example.com
Please enter a valid phone number.

Organization’s Officers And Membership Information

President
Vice President
Secretary
Treasurer
In which countries are your affiliates located?
Is your organization affiliated with any statewide consortium?

Explain why your organization is interested in becoming a member of the new jersey black issues convention:

Name of Designated NJBIC representative:
Name of Alternate NJBIC representative: