Membership Application - Individuals of African Descent | Black Alliance for Peace Powerbase

Thank you for your interest! Please make sure to read the Principles of Unity before filling out this form. If, as an African/Black applicant, you cannot afford the fee, please fill out this form. Problems with this form? Email membersupport@blackallianceforpeace.com

Annual Membership Dues *

Individuals of African Descent - $ 25.00

Please renew my membership automatically.

↻ Recurs yearly starting immediately

Total Amount

Application - Individual of African Descent

First Name *

Last Name *

Pronouns

Are you of African descent? *

Yes

No

Have Read and Agreed to the Principles of Unity *

Yes

Describe past and current political and organizational work you’ve been involved in that serves people of African descent. *

Email Address *

Phone *

.

Mailing Address (optional)

Apt / Building #

City *

State *

Postal Code

Country

Non English Known Languages - Spoken or Written