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:   
Business Activity: 
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 Developed and Maintained by Webchoice Consulting  site map