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.  Please print the following form, fill-in, and fax to the BWUFA office at (703) 313-8716.

Black Women United For Action
Membership Dept. 
6551 Loisdale Court, Suite 400
Springfield, Virginia 22150
(703) 922-5757 Voice
(703) 922-7861 Fax

ENROLLMENT INFORMATION:

I am a:  _______New Member       _______Renewing Member

Name:  _______________________________________________

e-mail:  _______________________________________________

Address: _____________________________________________
              _____________________________________________

City: ______________   State: __________    Zip: __________

Telephone (Day): ______________________________________
                (Eve): ______________________________________

MEMBERSHIP INFORMATION:

_____  Member ($30.00)

_____  Student ($15.00)

_____  Family ($100.00)

_____  Patron ($500.00 - includes name on letterhead as Patron, 2 invitations to one BWUFA sponsored event.)

METHOD OF PAYMENT:

______ 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:

Id 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            ______Children's Programs
_____ Committees                          ______CFC Contributions
_____ Monthly Meetings                  ______Volunteering
_____ Outreach Programs

COMMENTS:

_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

Please make all checks payable to:

BWUFA, Inc.

Applicant Accepted by: _____________________________________
                                                   (BWUFA Chair or Finance Sec.)

Approved by: _____________________________________________
                                                   (President)