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Illinois Chapter Membership Application
The National Organization of Professional Black NRCS Employees (The Organization)
Logo of The Organizational

Any person or organization subscribing to the goals of the National Organization
of Professional Black NRCS Employees may submit a membership application.
 Complete online or hard-copy application.  Print and mail with payment to:
Gwinne Kindle, Treasurer
2118 W. Park Court, Champaign, Illinois 61821
Phone: (217) 353.6612
Make check payable to: The Organization-Illinois Chapter
Send 2 copies to the Treasurer and keep 1 copy for your records.  You may copy and distribute applications freely.

Choose Type of Membership
 Illinois Chapter Membership ($15.00) (You must be a member of the National Organization in order to be a member of the state chapter.  National Level does not process/accepted Chapter dues).

1-Year National Membership ($45.00)
Applicable to anyone who desires to be a member of The Organization. 
(Illinois Chapter will accept and forward your National dues to the National Financial Secretary)		 Sustaining Annual National Membership
 Applicable to any regular annual member who contribute
$130.00 or more annually towards the support of the Organization.
     I prefer to mail my payments
     I prefer Direct Deposit
Lifetime National Membership ($500.00)
    1 payment ($500.00)    2 payments ($250.00)
    4 payments ($125.00)    5 payments ($100.00)
    8 payments ($62.50)    10 payments ($50.00)		 Sustaining Life National Membership
 Applicable to Life members who contribute $130.00
or more annually after obtaining Life Membership status.
      I prefer to mail my payments
      I prefer Direct Deposit
Information About You
First Name M.I. Last Name
Title Agency     Other
Office Address
City State Zip
Phone Fax E-mail

If you prefer to receive Organization mailings at a different address please provide mailing information below.
Mailing Address
City State Zip
Yes I would like to be listed in The Organizations Network Directory!

  What Region are you in?:
East   Midwest   Northern Plains   South Central    Southeast   West
 Are you a Chapter Member?       (if Yes which chapter?) select chapter
If asked, I am willing to serve on the State or National Committee

 Total Enclosed   Signature___________________________________________    Date___________
 For Official Use Only:  Date Received:_____________        Authorized Initials____________