2007-2008 Membership Form

Please Check Membership Type:

  $ 15 Individual (Section A+C)                    $ 35 Corporate-Profit (All Sections)

$  5 Student  (Section A+C)                      $ 25 Corporate-Non-Profit (All Sections)

  No Cost-Associate (Section A+C)             $    Additional Donation

Please Check Membership Category:

  Voting Member (I will attend at least 8 General Meetings.)

  Non-Voting Member (I will not attend at least 8 General Meetings.)         

Name: 

Title:

Organization:

Mailing Address:

Office Phone:      Home Phone:  

Fax:   Cellular: 

Email:         Date: 

Organization Name: 

CEO Name: 

Mailing Address:

Office Phone:      Fax:  

CEO Email:         Date: 

 I am interested in the following committees:

Education/Youth                                 Membership

  Health                                                Resource

  Media                                                Finance 

Please list my other interests:  

Make checks payable to:          Hispanic Latino Coalition, Inc.

                                               1750 17th Street, Building K-3

                                                Sarasota, FL 34234

Phone (941) 955-5834

Email: hispaniclatinocoalition@verizon.net