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Rockdale-Newton Section

MEMBERSHIP/RENEWAL APPLICATION

DATE:

NAME:

Address

Email

Phone

BIRTHDAY: MM/DD

NCNW ffiliate Organization(s):

Type of Application

New Membership

Renewal of Membership

Lifetime Membership

Legacy Life

Membership Dues Paid:

National Dues Paid $50.00

Local Dues Paid $90.00

Total Dues Paid $140.00

Lifetime $500.00

Legacy Life $1000.00

Dr. Dorothy I. Height & Dr. Mary McLeod Bethune

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