Orange County Chapter Founded in 1981

Application for MANA Membership

Yes, I want to join the MANA de Orange County Family!

Enclosed are my membership dues for the year:

o Regular $40.00 o Senior $25.00 o Student $10.00 Full Time (18 yrs +)

NOTE: Your Name, Phone and Email address will be included in our Member Directory.

Name: ___________________________________________

Address__________________________________________

City/Zip _________________________________________

Home Phone ( ) ____________________ Email: _______________________________________________

Your Business Name, Phone , email and website can be included in our Business Network section of the Member Directory.

Company _________________________________________

Business Phone ( ) __________________

E-Mail ___________________________________________

Website URL ______________________________________

PLEASE select at least one Committee that you are interested in:

MANA de Orange County is a Not For Profit 501 (c)(3) Organization.

Please make your check payable to:

MANA de Orange County

Mail to: 1913 E. 17th Street, Suite 210 Santa Ana, CA 92705

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