NJBIC MEMBERSHIP -

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 Issues 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.
Name of Organization
Organization Contact Information
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number (Day)
Please enter a valid phone number.
Phone Number (Evening)
Please enter a valid phone number.
Email
example@example.com
Fax Number
Please enter a valid phone number.
Organization’s Officers And Membership Information
President

First Name Last Name
Vice President

First Name Last Name
Secretary

First Name Last Name
Treasurer

First Name Last Name
Total Number of Organization Members:
How many chapters comprise your organization?
In which countries are your affiliates located?
Is your organization affiliated with any statewide consortium?

YES NO
If so, please list the organizations: *
Explain why your organization is interested in becoming a member of the new jersey black issues convention:
A. Indicate how your organization can contribute to the mission of NJBIC
B. What type of statewide projects has your organization undertaken?
What type of statewide projects/issues does your organization recommend NJBIC undertake in the future?
Name of Designated NJBIC representative:

First Name Last Name
Name of Alternate NJBIC representative:

First Name Last Name
Membership Fee *
Should be Empty:

NJBIC MEMBERSHIP APPLICATION

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

New Jersey Black Issues Convention Membership

Organization Contact Information

Organization’s Officers And Membership Information