2007
Membership Application
Applicant Information
Name_______________________________
Agency_____________________________
Address_____________________________ City__________________ Zip___________
Phone # ____________________ cell / w / h E-Mail ____________________________
Latino Outreach
Interests:
O Health O Education O Housing
O Employment
O Socials O Workshops
O Mixers O Networks
O Community Events
(Please mark all interests)
2007 Latino Outreach Council
Annual Membership Dues are $10.00
Please make check payable to: Latino Outreach Council
Mail to: P O Box 15960
San Luis Obispo, CA 93406-5960
Tax ID #77-0413791