The National Coalition of 100 Black Women, Long Island Chapter, Inc., is a not-for-profit organization, whose vision is the full participation of Black women in the mainstream of Long Island economy.  

Individual Registration

Please enter information in the form below to process registration for the 2018 Black and White Ball.
Required fields are marked with a red asterisk.

First Name *
Last Name *
Email Address *
Address *
Address 2
City *
State *
Zip *
Phone *
Number of Tickets
Member Name *
Ticket 1 Guest Name
Ticket 2 Guest Name
Ticket 3 Guest Name
Ticket 4 Guest Name
Ticket 5 Guest Name

Payment Information