MANA Membership Application
Application Type
*
NEW
RENEWAL
First Name:
*
Last Name:
*
Name:
*
First Name
Last Name
Birthdate:
*
-
Month
-
Day
Year
Date
Title:
*
Corporation/Organization:
*
What is your area of expertise:
*
Home Address (Street Address, City, State & Zip):
*
Cell Phone Number:
*
-
Area Code
Phone Number
Personal Email:
*
example@example.com
Work Address:
Work Phone:
-
Area Code
Phone Number
Work Email:
example@example.com
Preferred method of contact:
*
Home
Work
What areas are you interested in getting involved?
*
Mentoring HERMANITAS® in classroom
Speaking
Events Committee/Volunteer
Attending Events
Fundraising Committee
Membership Committee
Sponsorship
Other
What motivated you to join MANA de North County?
*
Networking
Build my Business
Empowering Latina Youth
Giving Back to My Community
All Things Latina
Professional Development
FUN! / Social Events
Other
Comments: Anything else you'd like us to know?
SELECT YOUR MEMBERSHIP
*
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( X )
Regular Membership (Standard)
(
$
45.00
for each
year
)
Standard Membership
College Student Membership
(
$
15.00
for each
year
)
Eligibility: Current College Students and up to 12 months from graduation date
HERMANITAS® Mentor
(
$
35.00
for each
year
)
ONLY Active Mentors working with our Hermanitas Director
Senior Membership (Ages 60+)
(
$
35.00
for each
year
)
Senior Couple Membership (Ages 60+)
(
$
50.00
for each
year
)
BOARD OF DIRECTORS MEMBERSHIP
(
$
90.00
for each
year
)
ONLY Active Board Members
Corporate Membership
(
$
250.00
for each
year
)
Corporations, Small Business, Entrepreneurs and Organizations, including nonprofit partners.
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