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Alianza Latina - Membership Interest Form

First Name:

Last Name:

Campus Address:

Home Address:

Office Phone:

Home Phone:

Fax Number:

Email Address:


Ethnic Affiliation (optional):

Research Interests/Areas of Expertise:

Please check membership status preferred:
Active Member (minimum attendance requirement of 60% of all meetings; active participation in events and activities; voting privileges; can submit absentee ballot)
Supporting Member (no attendance requrement; no voting privileges; will receive mailings of group events and activities; welcome at all activities)