Thank you in advance for becoming a member of CBPM
The Collective Black  People Movement (CBPM) Membership Application
1. Name:
Last
 Male
 Female
Nickname
First
2. Mailing Address:
street
street number
 Apt #
country
city
 Zip Code
state
3.  Phone Number
Home
Cell
Business
4. Email Address:
 Website Address:
Place of Birth:
5. Birthday:
City/State/Country
Month/Date/Year
6.  How did you hear about the Collective Black People Movement (CBPM)?
7.  What special skills do you have that can benefit our people?
8.  Education:  List your High School, Trade School, College, University, and/or Military experience below
along with the location, subject(s) studied, and years attended.
Name of School
(H.S., Trade, college, Univ.)
 City & State
 Subject Studied
 Years
Attended
1.
2.
3.
4.
9.  Work Experience:  List the areas of work that you are capable of doing for your people:
B.
C.
A.
10.  Do you have a business?  If yes, list it (them) below, so that we can advertise your business to our
people.  Please send us a business card or a flyer..
Name:
Type:
 State:
 Phone #:
City:
Address/Location:
1.
2.
11.  Type of Membership:
a.  Check the type of membership you are interested in with the Collective Black People Movement.
b.  Check how you would like to pay your membership (by the day, week, month, etc.)
             Day           Week         Month         3 Months       6 Months            Year                 
Individual       27 Cents       $1.89          $8.10             $24.30            $48.60               $97.20

Student          15 Cents        $1.05         $4.50              $13.50            $27.00               $54.00

Elder               20 Cents        $1.40         $6.00              $18.00            $36.00               $72.00

Family             75 Cents        $5.75         $22.50            $67.50            $135.00            $270.00

Organization    $1.00            $7.00        $30.00            $90.00            $180.00            $365.00

Business          $1.00            $7.00        $30.00            $90.00            $180.00            $365.00

Church             $2.00           $14.00        $60.00          $180.00           $360.00            $730.00

Honorary          $1.00            $7.00         $30.00            $90.00           $180.00            $365.00
If you signed up for a Family, Organization, or Church Membership, how many people is in your group?
12.  Check the Departments you would like to be involved with the Collective Black People Movement.
Elder Council
All Departments
 Physical Fitness
Activist/Rallies/Letter Writing
 Political
Employment
Administration
 Engineering
 Promotions
Arts & Crafts
 Farming/Produce
 Reparations
Brothers Union
 Filming & Recording
 Repatriations
Business Operations
 Fundraising
 Research
Child Care
 Health & Nutrition
 Security
Computers
Hip-Hop
 Sisters Union
Construction
History
 Special Events
Correspondence
 Incarceration
 Spirituality
Culture
 Law