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.  
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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

$
$
$
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