Membership Application

To join MANA:

1) Print a copy of this membership application.
2) Fill out form (type or print) and sign
3) Mail completed form and membership fee to:

MANA A National Latina Organization
Attention: Lily Amare
1146 19th Street NW, Ste. 700
Washington DC, 20036

Membership Application

Date: ______________________________________

Name:______________________________________

Title: _______________________________________

Organization:_________________________________

What is your area of expertise? (ex. computers, accounting, writing)_________________

HOME INFORMATION

Address _______________________________________________

Phone: ___ _______

Fax: ___ _______

E-mail ___________________

WORK INFORMATION

Address _______________________________________________

Phone: ___ _______

Fax: ___ _______

E-mail ___________________

Preferred mailing address ( ) Home ( ) Work

Type of Membership:
( ) Student $15                                 ( ) Friend $100 (non-voting supportor)
( ) Senior Citizen $15                     ( ) Lifetime Membership $250
( ) Regular Membership $35        ( ) I want to support the development and education of Latinas. Here is my donation $_________
( ) Renew my current membership

SIGNATURE ________________________________________