info@nationalsclc.org | 1 (404) 522-1420

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Chapter Payment Form

Our chapters are the heart and soul of what we do. Thank you for the tireless work and dedication you put into your communities.

Please use this form to conveniently pay our charter fee and/or memberships online you have collected funds for.

Please call us at (404) 522-1420 with any questions
Contact Name*

PrefixFirst NameLast Name
Name of Chapter
Chapter Name
E-mail*
Phone Number*

Area CodePhone Number

Amount

Annual Charter Fee$400.00

Drum Major$500.00

Quantity

Dream Keeper$250.00

Quantity

Freedom Fighter$100.00

Quantity

General Membership$25.00

Quantity

Senior Membership (65 and over)$10.00

Quantity

Faithful Servant$50.00

Quantity

Youth Membership$10.00

Quantity

Student Membership$10.00

Quantity

Lifetime Memberhsip$2,000.00

Quantity

Enter coupon

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Credit Card/ACH Authorization

The National SCLC is accepting your payment via credit card or ACH authorization. We use these payments to collect chapter fees ($400) membership dues, and/or contributions.

We are collecting information about you in order to process your payment. We will never sell this information. This information may be shared within SCLC as well as our sister organizations.

Your online or telephone submission will serve as your acknowledgement of completion of this form.

Please email us at accounting@nationalsclc.org with any questions or concerns about this policy. You may also reach us at (404) 522-1420 with any questions.
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