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MEMBERSHIP/ORDER FORM

PLEASE PRINT/TYPE ALL INFORMATION, AS THIS FORM MAY BE DUPLICATED

Date:

Levels of membership/donations and book orders (please check appropriate boxes):

for calendar year 20

Two-person family memberships

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$80

Member

$40 national, $40 local

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$100

Gold member

$40 national, $40 local, $20 donation

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$200

Platinum member

$40 national, $40 local, $120 donation

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$1,200

Life member

$1,000 national, $40 local, $160 donation

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$10,000

Afterlife member

$1,000 national, $40 local, $8,960 donation

Books/DVDs

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$25

A Life Worth Living

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$25

One Man’s Journey

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$50

With the Faith of Benjamin

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$50

My Country, Too

Amount enclosed: $

New member: { }

Membership number:

MEMBER

NAME:

FAMILY MEMBER NAME:

_

STREET:

CITY/STATE/ZIP:

TELEPHONE:

EMAIL:

_ STREET: CITY/STATE/ZIP: TELEPHONE: EMAIL: Please make checks payable to AAHGS Nashville and mail to:

Please make checks payable to AAHGS Nashville and mail to:

AAHGS Nashville 3415 West End Ave, Suite 1104E Nashville, TN 37203

AAHGS Nashville is a 501(c)(3) not-for-profit organization. Your membership is tax deductible.

Tax ID No. 86-1149630

Chartered Nov. 12, 2005, AAHGS Nashville is part of The Afro-American Historical & Genealogical Society, Inc. network of chapters, the premier organization dedicated to documenting and disseminating African-American genealogy and history. Headquartered in Washington, D.C., AAHGS focuses on promoting scholarly research, providing resources for historical and genealogical studies, creating a network of people with similar interests, and assisting members in disseminating history.