NCHR - Membership Form

NCHR Membership Form

Given concerns about security, we suggest that you print this form, fill it out and send it along with your check or money order via mail or fax to NCHR

National Coalition for Haitian Rights
275 Seventh Avenue
New York, NY 10001
Phone: 212-337-0005; Fax: 212-741-8749

It is also possible to securely donate online at our page at GuideStar.org.

Yes, I am proud to be a member of the
National Coalition for Haitian Rights
Please send me HAITIInsight and my new NCHR membership card right away.

Individual Membership Request

Please register me as a (please check one):

US $25 Member
US $50 Sustaining Member
US $100 Sponsor
US $200 Patron
US $500 Benefactor
Other (write in the amount)

(The minimum donation for individual membership is $25. Contributions in excess of $25 are tax-deductible to the full extent of the law)

Organizational Membership Request
Please note that organizational membership is limited to groups established in the United States.

Minimum organizational membership fees are on a sliding scale basis, in accordance with the following formula:

Our organizational membership contribution should be set at (please choose one)

$100 for an annual budget of less than $100,000;
$250 for an annual budget between $100,000 and $300,000;
$350 for an annual budget between $300,000 and $500,000;
$500 for an annual budget greater than $500,000.

Additionally, we will contribute $ as part of our commitment to NCHR.

Name and Address
Please indicate below name and address where we should send the invoice

First Name:

Last Name:

Organization/Affiliation:

Address:

City: State:

Zip: Country:

Tel.: Fax:

E-mail:

I have enclosed a check or money order in the amount of US $_____
Please bill me.
I am submitting my donation online via GuideStar.org.

(send in Request) (clear this request)

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