Membership Application Form

Hispanic Image Membership Application

To apply for membership please complete all questions.
Name

First NameLast Name
E-mail
Birthday

MonthDayYear
Date
Phone Number
Business/Organization name
Personal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Describe you business (describa su empresa)*
Business social media accounts (CUENTAS EMPRESARIALES EN REDES SOCIALES)
What interests you about being a member of HISWBH? Porque Deseas ser un miembro de HISWBH? *
What has been your prior experience with nonprofit membership organizations?/ Cual ha sido tu experiencia en una organization sin fines de lucro?*
What is your fundraising experience?/¿Cuál es su experiencia en recaudación de fondos?*
What type of leadership roles have you held?/ ¿Qué tipo de roles de liderazgo ha ocupado? *
Upload (Logos, Professional Pictures, Biography)

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Memberships*

Basic Membership $ Free

Prestige Membership$350.00

Prestige Corporate Membership$1,000.00

Total $0.00

Credit Card

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Cash App Pay

Hispanic Image Membership Application