New Membership Form
Jan. 2013 - Dec. 2013
Please complete the form below.
Please check on this box if you DON’T want the information appear in our Mermbership Directory
Salutation:
--Select--
Dr.
Mr.
Mrs.
Ms.
Ph.D.
Business Activity:
--Select--
Agriculture
Answering Services
Arts & Entertainment
Attorney - Business
Automotive
Banking
Bankrupsy & Debt Collection Attorneys
Bookkeeping Services
Building Maintenance
Business Consultants
Business Phone
Clubs & Organizations
Computer & Software
Construction
Courier & Messenger Services
Credit Card Processing
Delivery Services
Direct Mail
Education
Finance
Food & Drink
Goverment & Social Services
Health & Medical Insurance
Health Care
Home & Office
Hotels & Accomodations
Insurance
Internet Advertising
Lending
Office Supplies
Public Relations Agencies
Real Estate
Recruiter
Rental & Leasing
Repair & Maintenance
Restaurant
Shopping
Sports & Recreation
Tax Preparation
Transporation
Travel Services
Utilities
Videography
Waste Management
Website Design
First Name*:
Middle Initial :
Last Name*:
Position / Title*:
Note: If you are a student please fill title as “Student”
Company/Organization*:
Street Address Line 1*:
Street Address Line 2:
City*:
State:
Zip / Postal Code*:
Business Phone:
Home Phone:
Mobile Phone:
Fax:
E-mail*:
GLA uses phone, fax and e-mail information to notify members about programs, products and services that may be of benefit to its members. If you prefer not to be notified in this manner, please check the box, and we will not include you in these communications.
* E-mail addresses and fax numbers are not sold to any third party.
INDIVIDUAL
$
50.00
COUPLES
$
75.00
STUDENTS
$
25.00
SMALL BUSINESS
$
100.00
(-50 employees)
CORPORATIONS
$
250.00
(+50 employees)
P.O. Box 806, Verdugo City, CA 91046
©
2013 GLENDALE LATINO ASSOCIATION. All rights reserved
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