Corporate Membership Application

Company Name:______________________________________________________   Contact Name:   ______________________________________________________   Mailing Address:______________________________________________________   City:_________________________State:_________Postal code:________________   Business Telephone:____________________  Cell Phone:________________________   E-mail Address:_________________________________________________     (Membership Bio Information)   Place of Employment:   _________________________________________________   Profession:                      _________________________________________________   Current Board or Committee Appointments: _________________________________________________   Areas of Interest:          _________________________________________________   Expertise (or areas of strength)          _________________________________________________       By Signing this below, I agree to abide by all Hispanic Voices  rules as set forth by the Board of Directors.   Signature:_____________________________________Date:_________________ Please enclose this form, along with a check for $ 250.00 (U.S.) for your annual corporate membership payable to... Hispanic Voices.   Hispanic Voices 8958 W. 89th Ave St. John, IN, 46373