MEMBERSHIP APPLICATION AND CHANGE OF ADDRESS FORM

For National Office Use Only

U.S. GAO CHAPTER
P.O. BOX 50533

Washington, DC 20004-0533

Name Last:
First: Middle 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: Federal State Local Retired Other Agency: GAO Retired Other
Other: Location:: Headquarters Regional Office Other

Business Address Street:
City:

Office Symbol or Mail Stop: State:
Zip Code:

Type of Membership: Regular (New) Regular (Renewal) Associate (New) Associate (Renewal) Life Membership (New) Life Membership (Chapter Dues)
Name of Chapter:

Membership Number:

E-Mail Address:

I would like to receive electronic correspondence from BIG: Yes No

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National Membership

Regular membership dues are $35.00

Associate membership dues are $25.00

Life membership dues are $300.00

Chapter Membership

Chapter membership dues are $10.00

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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:

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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:

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Please print-out the above form (Legal Size Paper) and mail it, along with the correct payment, to the Blacks In Government-GAO Chapter, Attn: Membership Chairperson, at the address listed below.   Please do not send your membership payment directly to the BIG National Office.

Please make check or money order out to the Blacks In Government-GAO Chapter. Please do not mail cash.  Payment in U. S. currency only.

Please mail your chapter membership application and payment to:

Blacks In Government-GAO Chapter, Attn: Membership Chairperson, P. O. Box 50533, Washington, D. C.  20004-0533

For more specific information on membership in the General Accounting Office Chapter, please contact Ms. Geraldine Howard, Membership Chairperson, on (202) 512-8376.