Blacks In Government
Independence Chapter
P.O.Box 45252
Philadelphia, PA 19124

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Department Employed By: Agency: Other:

Business Address Street: City:

Office Symbol or Mail Stop: State: Zip Code:

Type of Membership: Name of Chapter:

Membership Number:


National Membership

Regular chapter dues and national membership dues are $25.00 for a Regular membership, $15.00 for a Associate membership, and $250.00 for a Life membership .

Chapter Membership

Chapter dues are established and payable to the chapter. Eligibility of chapter membership is contingent upon payment of National membership dues to the chapter. Each chapter will collect all national dues and forward same to the National Office of BIG.


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 Number Area Code: Number:


New Information

Name Last: First: Initial:

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To receive additional information concerning Independence Chapter membership , please complete, print-out the above form and mail to the chapter membership chairperson. If you are renewing your chapter membership, please mail the above form with the correct payment to the Independence Chapter, attn: membership chairperson.

Please do not mail cash. Payment in U. S. currency only.


If you will require any additional information concerning membership in the Independence Chapter

Membership Chairperson: David Brown


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