BIG membership application and change of address form

  For National Office Use Only

Blacks In Government
1820 11th Street, N.W.
Washington, D.C. 20001
(202) 667-3280
 (202) 667-3705 - FAX

  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:

  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:

National membership dues are $35.00 for a Regular membership, $25.00 for a Associate membership, and $300.00 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


National Membership

chapter. Each chapter will collect all national dues and forward same to the National Office of BIG.

We encourage all Blacks In Government members to become an active member of a chapter within their Region.


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 and mail, with the correct payment to the national office of Blacks In Government. If you are renewing your chapter membership, please mail the above form with the correct payment to your chapter membership chairperson.

Type of Payment method: Check: 
 Money Order:    Purchase order:   

Credit card:     Master Card          VISA  

If you are paying by credit card, you can fax ([202] 667-3705) your membership form to the national office of Blacks In Government and Ms. Peggy Downing will contact you to obtain your credit card number and expiration date.

Please: "Do Not" fax or mail your credit card number or expiration date.

If you are paying BIG national membership dues, your completed membership form will be forwarded to the Regional Council President in the state which you reside and they will contact you about chapter membership within your city.

For payment of national dues, please make check or money order payable to:   National Organization of Blacks In Government.

For payment of chapter dues, please make check or money order payable to the local chapter.

Please "DO NOT" mail cash. Payment in U. S. currency only.

Blacks In Government
1820 11th Street, N.W.
Washington, D.C. 20001


If you will require any additional information concerning BIG membership

Send E-mail To National Membership Chairperson

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