NYLPRW MEMBERSHIP APPLICATION

Please click on link above to download the Membership Application form.

 MEMBERSHIP APPLICATION  

“Educate a woman, and you educate a family.”

 

Name (Print) ______________________________________________________________________

                                    First                                                                                                        Last

 Address __________________________________________________________________________               

(Please include Apt. #)            City                                    State                                Zip Code              

 

Home Telephone (      ) __________________________ Work Telephone (      ) _____________________

Cell # __________________________________  Email Address _____________________________     

 Employed By ______________________________Title ____________________________________

(Or School Attending)   (Or Grade/Year, e.g. Sophomore)

 Work Address _____________________________________________________________________

                                                            (Include Dept., Room #, or Suite#)

 Work Address _____________________________________________________________________

(Please Attach Your Business Card)      City                                  State                                          Zip Code

NOTE: Application for Membership is subject to the approval of the Executive Board.

MEMBERS (MEN & WOMEN – NEED NOT BE HISPANIC )
Individual (Employed Full Time)	[    ]     $60.00
Employed Part Time, Unemployed, Retired or Full Time Student	[  ]        $30.00
Corporation or Group	[    ]      $500.00

 Membership entitles you to $100 discount off of your $180 Gala ticket.  As a Member, you pay only $80 to attend our Gala Dinner Dance at the Marina Del Rey in the Bronx.

 Contribution:  $_____________________Total Enclosed: $___________________________________

     (NO AMOUNT IS TOO SMALL.)                         

 

Please make check payable to: NY LEAGUE OF PUERTO RICAN WOMEN, INC.

& mail to:  NY League of Puerto Rican Women, Inc.

                      P. O. Box 60337, Brooklyn, New York 11206-0337

 

Applicant’s Signature ______________________________  Date: _____________________________