MEMBERSHIP APPLICATION

I/WE WOULD LIKE TO BECOME A MEMBER OF

UNA VOCE AMERICA LOS ANGELES WITH

ANNUAL DUES OF:

____$10.00 FOR INDIVIDUAL MEMBERSHIP



____$15.00 FOR FAMILY MEMBERSHIP



NAME_________________________________________________________________



MAILING ADDRESS____________________________________________________



PHONE NUMBER_______________________



FAX NUMBER__________________________



E-MAIL________________________________

PLEASE PRINT PAGE AND MAIL WITH YOUR CHECK OR MONEY ORDER MADE PAYABLE TO "UNA VOCE" TO:

UNA VOCE LOS ANGELES

P.O. BOX 3251

CULVER CITY, CA 90231-3251



COMMENTS OR QUESTIONS: