Become A 21st Century Abolitionist

JOIN THE MOVEMENT
Become a 21st Century Abolitionist

Thank you for your interest in becoming a 21st Century Abolitionist. We hope you will find a membership level that best fits your desires
and know you will be encourage by the bulk of work we are doing in the name of 19th Century Abolitionist Frederick Douglass.
The Frederick Douglass Foundation encourages anyone to apply for membership. We do not discriminate based on gender, race, class,
economic status, ethnic background, sexual orientation, age, physical ability, cultural and religious backgrounds."

Please Complete The Application Below and Submit.
Credit Card Payment Can Made After Submitting Your Application

First Name:

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Middle Name:

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Last Name:

Email Address:

Best Contact
Number:

Mailing Address

City

State

Zip Code

Political Party Affiliation

Which State Chapter would you like to be affiliated with? If
your state is not listed, would you be interested in organizing
the chapter in your state?

I am interested in starting a State Chapter of the
Frederick Douglass Foundation

Referred By

Enter N/A if no one referred you

MEMBERSHIP LEVELS AND BENEFITS

Membership Must Be Paid in Full To Receive Complimentary Registration and Discounts
Payment Options Available For Each Level: Complete Form and Submit to Review 12 Month Options (Credit Card Only)
Membership fees and benefits subject to change without notice.

MEMBERSHIP RENEWAL
Print Your Current Membership Number Here

HIGH SCHOOL/COLLEGE STUDENT -
Annual Dues $50 or Monthly Installment $5

Reduced registration to attend the Annual Leadership Summit
Year Subscription to the Freedom Journal e-Magazine
Member receives - quarterly e-newsletter
Personal copy of the US Constitution

If you choose this membership level, you must provide the name of the
school and city of its location you are attending

FRIENDS OF FREDERICK DOUGLASS -
Annual Dues $100 or Monthly Installment $10

$25 off registration to attend the Annual Leadership Summit
Year Subscription to the Freedom Journal eMagazine
Member receives - quarterly e-newsletter

21st CENTURY ABOLITIONIST -
Annual Dues $250 or Monthly Installment $25

In addition to the Friends benefits, you will receive:

25% off registration to attend the Annual Leadership Summit
Personal Copy of 2010 edition of "My Bondage and My Freedom
Member receives - quarterly e-newsletter

PLATINUM ADVOCATE-
Annual Dues $500 or Monthly Installment $45

In addition to the 21st Century benefits, you will receive:

50% off registration to attend the Annual Leadership Summit, VIP
Personal Invitation to attend the Annual Leadership Summit Receptions and Awards
Banquet.
Recognized and be listed throughout the Annual Leadership Summit
Link to the PLATINUM member's individual or company's website from the Frederick
Douglass Foundation website.

ELITE FREEDOM FIGHTER-
Annual Dues $750 or Monthly Installment $65

In addition to the Platinum Advocate benefits, you will receive:

Complimentary registration to attend the Annual Leadership Summit, VIP Receptions
and Awards Banquet.
Recognized and be listed throughout the Annual Leadership Summit
Link to the ELITE member's individual or company's website from the Frederick
Douglass Foundation website

How would you like to pay for your membership? Once your application has been approved, we will
invoice you for immediate payment in order to activate your membership and receive the appropriate
benefits

One-Time Payment

Monthly Payments

Mail Check

Credit Card/Paypal

An annual discount of 25% will be provided for the second family member's membership when joining
together. Last name and mailing address must be the same. Please provide your family member's name
in the comment box below in order to apply the discount.

Comments:

Click Here to Download Your Frederick Douglass Foundation Membership Application
Print Legibly and Mail the Completed Application to
Frederick Douglass Foundation, Inc.
Attn: Member Services
PO Box 50273
Washington, DC 20091

The
Frederick Douglass Foundation

"Where justice is denied, where poverty is enforced, where ignorance prevails, and where any one class is made to feel that society is an organized conspiracy
to oppress, rob and degrade them, neither persons nor property will be safe." - Frederick Douglass -

The Core Pillars of the Foundation

"Devoted Christians - Proud Americans - Active Republicans"

WE BELIEVE IN THE SANCTITY OF HUMAN LIFE AND THE PROTECTION OF TRADITIONAL MARRIAGE

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