NATIONAL COUNCIL OF NEGRO WOMEN, INC. (NCNW)

Prince George’s County, Maryland Section ( Founded 1981 )

P.O. Box 47373

District Heights, Maryland 20753

NAME:_____________________________________________________________

ADDRESS:__________________________________________________________

CITY:_______________________________________________________________

PHONE NUMBERS:

(HOME):_________________________ (WORK):__________________________

E-MAIL:____________________________________________________________

Date of Birth:_________________________

( Month/Day )

Type of Membership

Please Check one : __ Renewal __ New Date:__________________

LOCAL ( PRINCE GEORGE’S COUNTY SECTION )

__ $50 Includes National Membership

($25 payable to National, $25 payable to local section)

__ $25 Life Members

__ $35 Affiliate Membership

__ $35 Associate ( Men – Includes National )

NATIONAL

__ $25 National Only

__ $500 Life Membership

__ $500 Associate Life Membership

__ $25 Associate ( Men- National Only )

__ $10 Student

Please check appropiate affiliation and make check payable to :

NCNW - Prince George’s County, Maryland Section

Please Fax to : 301-888-9648

or mail to the address above