Youth Backer $1,000 or more	Gold Membership $500 - $999
Silver Membership $250 - $499	Bronze Membership $100 - $249
Family Membership $50 - $99	Sustainer $25 - $49
Youth (to 21 years of age) $10	Urban League Young Professional

Enclosed is $_________ in memory of _____________________________ (Please Print)

NAME: ______________________________________________________________________________

ORGANIZATION:_____________________________________________________________________

ADDRESS: ___________________________________________________________________________

CITY/STATE/ZIP: _____________________________________________________________________

TELEPHONE (Daytime): _____________________ALTERNATE TELEPHONE:____________________

E-MAIL: _____________________________________________________________________________________

Select payment method:

Check enclosed payable to Birmingham Urban League

Credit Card Select one MasterCard VISA

Credit Card#: _______________________________

Expiration Date____/____ (Month/Year)

Please mail to:

Birmingham Urban League
P. O. Box 11269
Birmingham, AL 35202-1269

THANK YOU FOR YOUR SUPPORT!