• CPG,INC - OHBCUD Registration Form

    Complete the form below to sign up for our membership service.
  •  -
  • PLEASE FILL IN SECTION THAT APPLIES TO YOU!

  • NAME/STATE OF HBCU OR PBI NOW EMPLOYED, ATTENDING OR COMPLETED:

  • (A) CURRENT STUDENT & RANK AT HBCU OR PBI: (FEE = $ 10 ANNUAL)

  • (B) ALUMNI/GRADUATE OF HBCU OR PBI: (FEE = $ 20)

  • (C) REPRESENTATIVE OF LOCAL COMMUNITY ORGANIZATION: (FEE = $ 40)

  • (D) CURRENT EMPLOYEE - TITLE/POSITION AT HBCU OR PBI: (FEE = $ 25 ANNUAL)

  • (E) INSTITUTIONAL MEMBERSHIP: ($700 annual fee)

  • (F) Fraternity/Sorority Name:

  • (G) General Donor (Non-HBCU/PBI) ($15 min. request)


  • prevnext( X )
    USD
  • Once you submit your application, we will contact you shortly to confirm your payment and membership.

    Thank you!

  • Should be Empty: