MANA Membership Application

MANA Membership Application
Application Type*

NEWRENEWAL
First Name:*
Last Name:*
Name:*

First NameLast Name
Birthdate:*

MonthDayYear
Date
Title:*
Corporation/Organization:*
What is your area of expertise:*
Home Address (Street Address, City, State & Zip):*
Cell Phone Number:*

Area CodePhone Number
Personal Email:*
example@example.com
Work Address:
Work Phone:

Area CodePhone Number
Work Email:
example@example.com
Preferred method of contact:*

HomeWork
What areas are you interested in getting involved?*

Mentoring HERMANITAS® in classroomSpeakingEvents Committee/VolunteerAttending EventsFundraising CommitteeMembership CommitteeSponsorshipOther
What motivated you to join MANA de North County?*

NetworkingBuild my BusinessEmpowering Latina YouthGiving Back to My CommunityAll Things LatinaProfessional DevelopmentFUN! / Social EventsOther
Comments: Anything else you'd like us to know?

SELECT YOUR MEMBERSHIP*

College Student Membership($25.00 for each year)

Eligibility: Current College Students and up to 12 months from graduation date and renewable one year from joining.

Regular Membership (Standard)($50.00 for each year)

Standard Membership, renewable one year from joining.

BOARD OF DIRECTORS MEMBERSHIP($100.00 for each year)

ONLY Active Board Members

Enter coupon

Yes, I would like to receive updates and information about programs, events, and opportunities.Your contact information will only be used to share updates about our programs. We respect your privacy and will not share your information with third parties.No, I do not wish to receive updates at this time.
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