EmailMe Form - Carolina Black Caucus Membership Form

Name *

First Last

Phone

### - ### - ####

Email *

University CB#-Campus Mailing Address

Title

Department/School

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Mailing address if no campus address.

Membership Status *

Joining

Renewing

Membership Type
Membership is valid July 1st -June 30th *

Faculty /Staff Annual membership

Graduate Student Annual

Post Doc Annual

Friend of the Caucus Annual

Alumni (non-UNC employees) Annual

Facilities/Housekeeping Staff (free membership)

You will be redirected to the payment page.

Would you like to assist a committee? If so, please select committee(s) below.

Please let us know what you desire to gain from and/or what you hope to accomplish as an active member of the Carolina Black Caucus

Donate to the Caucus

$ Dollars . Cents

CBC is now a 501c3 organization! Your donation may be tax deductible.

Payment method

Online payment (you will be redirected to PayPal for credit/debit/PayPal a $2.00 convenience fee will charged)

CashApp ($UNCCBC1974)

Check (send to Ebony Martin)

When using CashApp please include your name in the note section. Checks should be made payable to Carolina Black Caucus. Mail to: Ebony Martin,121 Plano Drive Durham, NC 27703