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BIG membership application and change of address form

For National Office Use Only

BENJAMIN BANNEKER CHAPTER
GENERAL SERVICES ADMINISTRATION     P. O. Box 23704   WASHINGTON, D. C.  20026

Name Last:
First: Initial:

Home Address Street:
P. O. Box:

City: State:
Zip Code:

Home Phone Number Area Code Number:
Business Phone Number Area Code: Number:

Department Employed By: Agency:
Other: Location::

Business Address Street:
City:

Office Symbol or Mail Stop: State:
Zip Code:

Type of Membership:
Name of Chapter:

Membership Number:

E-Mail Address:


I would like to receive electronic correspondence from BIG:

Annual National Membership Dues

Regular  dues are $35.00

Associate  dues are $25.00

Life  dues are $300.00*

Gold Plus dues are $250.00*

*One Time Payment, only                                                               

Annual Chapter Membership Dues

Chapter  dues are $10.00

Change of Address Form

Old Information

Name Last:
First: Initial:

Home Address Street:
P. O. Box:

City: State: Zip Code:

Home Phone Number Area Code Number:
Business Phone Number Area Code: Number:

New Information

Name Last: First: Initial:

Home Address Street:
P. O. Box:

City: State: Zip Code:

Home Phone Number Area Code Number:
Business Phone Number Area Code: Number:

Please print-out the above form (Legal Size Paper) and mail it, along with the correct payment, to the Benjamin Banneker Chapter,  Attn: Membership Chairperson, at the address listed below.   Make check or money order out to the Benjamin Banneker Chapter.   Please do not mail cash.  

Please mail your chapter membership application and payment to:

Benjamin Banneker Chapter, Attn: Membership Chairperson, P. O. Box 23704, Washington, D. C.  20026.  Please do not send your membership application and payment directly to the BIG National Office.

For more specific information on membership in the Benjamin Banneker Chapter, please contact Ms. Anita Connelly, Membership Chairperson,  on  (202) 501-0981.

For additional information about the Benjanin Banneker Chapter and our programs, please visit our webpage:  BBC Home Page or e-mail BBC directly.

Updated: May 28, 2006

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