Member Application

Thank you for your interest in joining LULAC Cincinnati. Please complete the information below to start the application process. Once your application has been submitted, you will receive an invoice for your payment to complete your membership. IMPORTANT: 1) Please complete Business Information fields with your full name (COMPANY NAME = Your Full Name) 2) Select the city and the council that you want to be a member. 3) Each Council has different membership types and value.

Business Information

Company Name: *

Leave Blank:

Phone:

Comments / Questions:

City Council : *

Council:

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Cincinnati Member: $30.00
Cincinnati Student Member: $15.00

Payment Option:

Bill me Charge my credit or debit card

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