BWUFA - Online Membership Application

BWUFA
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Black Women United For Action
Membership Dept.
6551 Loisdale Court, Suite 400
Springfield, Virginia 22150
703-922-5757 Voice
(703) 971-5892 Fax

Membership Makes A Difference!

Black Women United For Action (BWUFA) is committed to working with your help to improve the quality of life for the community. By providing valued outreach programs to all women and their families, BWUFA helps to advance community service programs.

Enrollment Information

I am a:

New Member

Renewing Member

Salutation:

(Mr., Mrs., Ms., or Miss)

Name:

e-mail:

Address:

Address ( cont'd):

City:

State:

Zip:

Country:

Tel. Day:

Tel. Evening:

Your Comments:

Membership Information ( check one ):
	Member $30
	Student $15
	Family $100
	Patron $500 (Name on letterhead as Patron, 2 invitations to one BWUFA event
	Subsidy for an "at-risk" woman $15

Method of Payment ( check one ):

By Check MasterCard Visa

If you wish to pay by credit card, please submit the following information:

Credit Card Number:

Expiration Date:

Signature:

Additional Information:

I'd like more information about BWUFA's Membership Benefits without any obligation on my part. Please mail me information on the following:

Check all that apply

Social Activities Annual Report

Discussion Groups BWUFA Events

Community Programs Childrens Programs

Committees CFC Contributions

Monthly Meetings Volunteering

Outreach Programs

(All BWUFA contributions are tax deductible.)

Please allow four to six weeks for application processing.
Thank you.

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