Membership Application

Please complete the following information to receive all Benefits.

First Name:

Last Name:

ORGANIZATION:
ADDRESS:
CITY:

STATE:

ZIP :

PHONE:

FAX:

E-Mail:
Annual Membership:
(Please Check One)		 INDIVIDUAL __$50.00
   
  Couples _____$75.00
     
  Small Business (0-50 employees) $100.00
     
  Large Business (over 50 employees) $250.00
     
  Students _____$25.00
     

PLEASE INDICATE AREAS YOU WOULD BE INTERESTED IN:

MEMBERSHIP NEWSLETTER
SCHOLARSHIPS PUBLIC RELATIONS
MIXERS PUBLICITY
COMMUNITY OUTREACH TO BUSINESS

WOULD YOU OR YOUR BUSINESS LIKE TO HOST A MIXER OR EVENTS?
 YES     NO

SUGGESTIONS OR CONTACT FOR SPECIAL GUEST SPEAKERS:

 

Please make check payable to:
GLENDALE LATINO ASSOCIATION
P.O. Box 806
Verdugo City, CA 91406