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United Latinos Membership Questionnaire
Please read instructions for each question before completing the form.
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First Name
*
Your answer
Last Name
*
Your answer
Address line 1:
Your answer
Address line 2:
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City:
Your answer
State:
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Zip Code:
*
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Phone Number
Enter in the following format: xxx-xxx-xxxx
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Email
*
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Please select your membership category:
Life Member -- $350
Annual Member -- $35
Senior Citizen (62+) -- $20
College Student -- $10
High School Student (w/ Parental Permission) -- FREE
Clear selection
Check mark your area(s) of participation interest
Board Member
Committee
Membership
Research Issues
Volunteer
Outreach
Internship Assistance
Scholarships
Voter Registration
Newsletter
Other:
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