I wish to become a sponsor at a

☐ Gold Level for $5,000/year                         ☐ Silver Level for $3,000/year     
☐ Bronze Level for $2,000/year                    ☐ Corporate Business Level for $1,000/year
 
Contact Name: _______________________________________________________________________________

Company/Organization Name: __________________________________________________________________

Address: ____________________________________________________________________________________

Phone/Fax: _________________________________________________________________________________

Email: _____________________________________________________________________________________

Website: ___________________________________________________________________

Society Joining (optional - please provid
e Network Partner code, S-09 for example, if desired)      ____ - _______

Referred by (name/organization): ________________________________________________________________

Payment Information

(note – membership can be paid online via PayPal following the link below)

Type of Credit Card: Visa ☐      MasterCard ☐

Name on Credit Card: ___________________________________________

Credit Card #: ____________________________________          Expiration Date: ______/_______

Security Code____________________

Billing Address for Credit Card: __________________________________________________________________

                                                  __________________________________________________________________

By electronically signing below, I authorize my membership fee to be charged to this card.

 

Signature: _____________________________________________Date ______________________


Email completed application to: PanAfrica@NBBSC.org

                                           ***************************************************************************

If you prefer to pay by check, make payable to the National Black Business Support Corporation

MAIL TO:   National Black Business Support Corporation
                  Attn: Society Sponsorship
                  113 S. Monroe Street
                  Tallahassee, Florida 32301

PAN AFRICAN CULTURAL HERITAGE SOCIETY SPONSORSHIP APPLICATION

Level
The plans of the diligent lead to profit as surely as haste leads to poverty. - Proverbs 21:5