2018 HRT Membership Application Form
For individual or Institutional Members
Dues can be paid online here
http://hispanicroundtable.org/wp/
Click on the PayPal donate button.
Please include a "membership" note in the "special instructions to the seller" field.
Name *
Your answer
Agency name (if Institutional Membership)
Your answer
Street Address *
Your answer
City, State *
Your answer
Zip Code *
Your answer
Is this a work address? *
Phone *
Your answer
Alt Phone
Your answer
Email *
Your answer
Alt Email
Your answer
Memberships to the Hispanic Roundtable of South Sound are renewable annually (with the exception of Individual Lifetime memberships). Annual dues expire on December 31st. *
If this is an institutional membership, please list the names and email addresses of employees to be covered. You may list up to five employees including yourself.
Your answer
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