Online Membership Registration Form Please fill out this form to register as a Latinas Unidas member: *New MemberRenew MembershipLatinas Unidas Membership Level*LU Member Level AmigaLU Member Level HermanaLU Member Corporate LevelThis is an annual membership renewable at the anniversary date Amiga Level (Free) Includes email updates Hermana Level ($50.00/year) Includes email updates, discount to regular Latinas Unidas events, Perks card for discounts from local businesses, listing in online directory with logo and link to website! Corporate Level ($500.00/year) Includes 10 memberships and 1 vote, along with email updates, discount to regular Latinas Unidas events, Perks card for discounts from local businesses Name* First Last Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* OccupationEmployerLanguagesCountry of HeritageI am interested in getting involved in the following: Clerical Support Cultural Activities Leadership Opportunities Networking Opportunities Newsletter Publication/Writing Reconocimiento Award Committee Technology Assistance/Website Scholarships Young Latina Issues Other How did you hear about Latinas Unidas? I went to a networking event A friend told me On Facebook On Twitter On the newspaper On the radio Other I would like to make a donation Total $0.00 Thank you for selecting a paid membership. Your membership is used to support our programs in the community.NameThis field is for validation purposes and should be left unchanged. You can also register by mail. Fill in, print and mail the form below with your payment to: Latinas Unidas PO Box 64611 Rochester, NY 14624 Download the registration form in PDF format. Please make your checks payable to “Latinas Unidas”. Thank you!