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	Small Business - $ 80.00 Non-voting member. Receives business card ad in newsletter.
	Supporting Member & Non-Profits - $ 50.00 Non-voting member.
	Regular membership - $ 30.00 Voting member.
	Students / Seniors (55+ years of age) - $ 20.00 Voting member. ID required for seniors.

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Organization Details

Organization Name

Primary Phone

Primary Email

Street Address

Street number, street name, apartment/unit/suite - OR P.O. box

Addt'l Address 1

Supplemental address info, e.g. c/o, department name, building name, etc.

Addt'l Address 2

City

Zip / Postal Code

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Enter optional 'add-on' code after the dash ('plus 4' code for U.S. addresses).

Country

State / Province

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Username *	Check Availability Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.
Password
Confirm Password	Provide a password for the new account in both fields.

Your Information

Referred by

Your first name *

Your last name *

Home phone *

Mobile phone

Home address

Address line 2

City

State

Zip

Business name

Title

Business phone

Business Email

Business address

Address line 2

City

State

Zip

Consent *

I Agree to Receive Communication
Read MANA's communication policy: READ

Committee Interests
Please select the committee(s) that are of interest you:
Brindis
Marketing/PR
Volunteer (events or one-time projects)
Hermanitas Committee
Hermanitas mentor
Fund Development
Membership/Mixers
Health Fair
Scholarship
Platicas (Educational Seminars)
Latina Success

MANA de San Diego

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