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Thank you for registering to participate!  Complete the information below and we’ll add you to the list of chapters around the country committed to making an impact, and investing in African American Families, Health + Wellness, and Education.  Once you complete the form the Primary Contact will receive a confirmation message with next steps.  Thank you!

    Your Name (required)

    Your Email (required)

    Chapter Name (required)

    Region (required)

    Number of Chapter Members (required)

    President (required)

    President Email (required)

    President Primary Phone Number (required)

    Foundation Chair (required)

    Foundation Chair Email (required)

    Foundation Chair Primary Phone Number (required)

    Primary point of contact for grant communication (required)

    Recommended non-profit (if known at this time)

    Specific philanthropic investment area (if known at this time)

    Social media handles for chapter

    Website address

    Chapter mailing address


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