NBPA
CHAPTER AFFILIATE MEMBERSHIP ROLL

All NBPA chartered Chapter Affiliates are required to submit an official Membership Roll listing individual members on January 1st and July 1st of each year. Failure to submit a completed Membership Roll will jeopardize the Chapter Affiliate's standing in all NBPA related activities. There is a $200.00 annual administrative fee.

CHAPTER AFFILIATE ORGANIZATIONAL DATA and OFFICIALS

CHAPTER AFFILIATE
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 
Charter Number 

PRESIDENT
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

VICE PRESIDENT
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

SECRETARY
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

FINANCIAL OFFICER
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

REGIONAL DELEGATE
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

REGIONAL DELEGATE
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

OTHER
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

OTHER
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

OTHER
Name  
Address 
City/State/Zip 
Day Phone 
Night Phone 

National Black Police Association
30 Kennedy Street NW - Suite 101
Washington, DC 20011
(202) 986-2070     (202) 986-0410 FAX