Alabama Hispanic Association

ALABAMA HISPANIC ASSOCIATION (AHA)                    

MEMBERSHIP APPLICATION                      

BENEFITS: The Alabama Hispanic Association is a charitable, tax-exempt, 501 (c)(3) non-profit organization. Any contributions over the basic membership are tax deductible.

     (  ) NEW MEMBER         (  ) RENEWAL

Name_______________________________________________________________________________

Address_____________________________________________________________________________

City______________________________________________ State_________ Zip Code_____________

E-Mail_______________________________________________________________________________

Home/Cell Phone_________________________                      Work Phone _______________________

                     (  ) please do not publish my address, e-mail or telephone number.

Occupation: ______________________________

Select the type of Membership:  Individual Membership ____ $25                 Student Membership ____$10

                                                      Friend of AHA ____$50                               Patron of AHA ____$100

Active Voting Members, please select the Committee or Committees you are interested in participating:

Grants                __________                         Scholarships       ____________

Membership       __________                         Outreach             ____________

Tutoring             __________                         Social/Cultural     ____________

Public Relations  __________                        Fundraising          ____________

Provide name(s) of known member(s) or associate(s) of the Alabama Hispanic Association:

____________________________________________________________________________________

Signature:  ______________________________________________________    Date: ______________

I UNDERSTAND THAT THIS MEMBERSHIP IS FOR THE PERIOD NOTED.  I FURTHER UNDERSTAND THAT ANY PERSON SEEKING ACTIVE MEMBERSHIP MUST FIRST BE NOMINATED BY THE MEMBERSHIP COMMITTEE AND FINALLY APPROVED BY THE BOARD OF DIRECTORS.

 MEMBERSHIP

Annual dues are due the 1st of January each year.

Make checks payable to AHA and mail with your completed application to:

Alabama Hispanic Association, 3921 Broadmor Rd. Huntsville, AL 35810

 __________________________________________________________________________________________________

           FOR OFFICIAL USE ONLY

Date Received   _______            

By ______________________

Amount Received _______          

Treasurer Received (date) _______

New Member _______                

Membership renewal _______

Packet Done _________

Packet Sent _________