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Membership

Thank you for your application. Your membership will be active after payment is recieved
First Name:
Last Name:
Title (optional):
Organization (optional):
Address:
City:
State:
(ignore for non-US transactions)
Zip Code:
Country:
Email Address:
Confirm Email Address:
Preferred Phone:
Credit Card Billing Address
 
 If the address where you receive the credit card bill is different than above, please enter it here.
Address:
City:
State:
Zip Code:
 

What benefits are you most looking for from your membership?
Would you like someone form the Latina Chamber to contact you after submitting this payment?
Are you a renewal member?
How did you first hear of the Latina Chamber?
Wouls you like to volunteer with the Latina Chamber?
Citrine: $100.00, Blue-Topaz: $250.00, Garnet:$500.00, Pearl: $1,000.00, Emerald:$3,000.00, Ruby: $5,000.00
Charge Amount:
Make this a Recurring Transaction? By default your card will only be charged today, with no recurrence set up. However, you can use the fields below to specify a recurring payment on the schedule of your choosing. Change the recurrence to specify how often your transaction will be processed. Specify an end date to stop transactions after a certain point in time (if you are unsure, use the expiration of your credit card).
Recurrence:
End Date:
Pay by Credit Card  
Card Type:
Credit Card Number:
Credit Card Expiration (mm/yy): /
Name On Card:
C V V Value: