Annual
Dues:
Cuota
Anual: |
$100.00
USD |
Payment
Method:
Método
de Pago: |
(*)
|
Important:
Importante: |
All
payments
are due
with
this
membership
application
form.
If
paying
by
credit
card,
please
fax
form to:
(202)
434-8072
La
cantidad
total a
pagar
deberá
cancelarse
con este
formulario.
Si desea
pagar
con
tarjeta
de
credito,
por
favor
envíe
este
formulario
por fax
al:
(202)
434-8072
|
Name on
Credit
Card:
Nombre
en la
Tarjeta: |
|
Credit
Card
Number:
Número
de la
Tarjeta: |
|
Expiration
Date:
Fecha de
Vencimiento: |
|
* Mail
check or
money
order to:
* Envie
cheque u
órden de
pago a: |
National
Hispanic
Caucus
of
State
Legislators
Hall
of
The
States
Building
444
North
Capitol
Street
N.W.
Suite
404
Washington,
D.C.
20001
Phone:
(202)
434-8070 |
