Sun, Dec 17, 2017
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Manhattan Chapter Membership Application
  1. ncbw logo

    National Coalition of 100 Black Women, Inc.
    Manhattan Chapter

  2. Personal Information
  3. Last Name
    Please type your last name.
  4. First Name
    Please type your first name.
  5. Init.
    Please type your middle initial.
  6. Street(*)
    Please type your Streetaddress.
  7. City
    Please enter your City.
  8. State
    Please enter your State.
  9. Zip Code
    Please enter your zip code.
  10. Home Phone
    Please enter your home phone number.
  11. Work Phone
  12. Other Phone
  13. E-mail(*)
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  14. E-mail is checked
    How often do you check your email?
  15. Date of Birth
  16. Marital Status
  17. # of Dependents
  18. Employment Information
  19. Title(*)
  20. Employer
  21. Occupation(*)
  22. Years Employed
    Educational Information
  1. Degree/Certificate
  2. Major/Specialization
  3. Year
  4. Degree/Certificate
  5. Major/Specialization
  6. Year
  7. Degree/Certificate
  8. Major/Specialization
  9. Year
    Affiliations
  1. Name(*)
  2. Focus
  3. Name(*)
  4. Focus
    Essay Questions
  1. How did you hear about the National Coalition of 100 Black Women Inc, Manhattan Chapter
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  2. Describe your strengths, skills, and special interests.
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  3. Describe the reason(s) why you want to become a member of the National Coalition of 100 Black Women Inc, Manhattan Chapter
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  4. What are your expectations of the National Coalition of 100 Black Women, Inc., Manhattan Chapter?
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  5. What will be your most significant contribution(s) to the National Coalition of 100 Black Women, Inc., Manhattan Chapter?
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  6. Of the committees that comprise the core operation of the National Coalition of 100 Black Women, Inc., Manhattan Chapter, which would you be most likely to participate in. You may choose more than one
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    Please use keyboard command "shift & mouse" to choose as many as you like.

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