Please print this for and submit it to:

NAACP

2221 North 24th Street

P.O. Box 11122

Omaha, Nebraska 68110

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Please return this section with your check or Money Order

NAME________________________________________________Dare_______________________

ADDRESS_____________________________________________Phone______________________

CITY_____________________________________STATE_______ZIP________________________

Membership:Regular............................................................. 30.00_______________________

Silver Life - $75.00 per year for 10 years

or 750.00______________________

Gold Life 1500.00______________________