TBAAL Membership Form
Mailing Address: The Black Academy of Arts and Letters, Inc. | 650 S. Griffin Street, Dallas, TX 75202 | 214.743.2441
Individual Membership
Circle One: Mr. Mrs. Ms. Dr. Rev. _______/_______
Birthday (Month / Day)
______________________________________________ ( ) New ( ) Renewal
First Name Middle Initial
____________________________________________________________________________
City State Zip Code
G
uest Membership (if applicable)
Circle One: Mr. Mrs. Ms. Dr. Rev. _______/_______
Birthday (Month / Day)
________________________________________________________ ( ) New ( ) Renewal
First Name Middle Initial
__________________________________________________________________________________
City State Zip Code
Circle One: Mr. Mrs. Ms. Dr. Rev. ________/________
Birthday (Month / Day)
_________________________________________________________ ( ) New ( ) Renewal
First Name Middle Initial
_________________________________________________________________________________
City State Zip Code
Business / Corporate Membership
____________________________________________________ ( ) New ( ) Renewal
Name of Business / Corporation
__________________________________________________________________________
City State Zip Code
( ) $20 ( ) $30 ( ) $ ( ) $100 ( ) $250 ( ) $500 ( ) $750 ( ( ( )
Payment Methods
( ) Cash ( ) ( ) ( ) Master Card ( ) ( ) Discover ( ) PayPal ( ) Cash pp ( )
_____________________________ Expiration: ______/_______ CVV: _________
Volunteer: ________________________ Date: _____/_____/_____
Revised Aug. 2020