5 membership form Please enable JavaScript in your browser to complete this form.Membership InformationCurrent Membership Status *New MemberExisting MemberHonorary Member [Non-Mecklenburg County Resident]Life MemberContact InformationName *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmployer Name *Occupation *Contact Number *Email *Political Information City Council DistrictSelect From Options Below123456OtherCounty Commission DistrictSelect From Options Below123456OtherSchool Board DistrictSelect From Options Below123456OtherCommittee Selection:MembershipBudget/FinanceEducationPublicityGOTVLegislativeBanquetIssues/CandidatesCourtesyCommunity AffairsEconomic DevelopmentMembership Levels (Please Select One)Membership Levels *General Membership ($30.00 + $3.00 service fee) - $33.00Honorary Member ($30.00 + $3.00 service fee) [Non-Mecklenburg County Resident] - $33.00Lifetime Membership ($500.00 + $25.00 service fee) - $525.00Total Amount$0.00Submit
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