MEMBER INFORMATION      

Name: Title:  

Company/Organization:

Year Established:

Address:

City: State: Zip:

Phone: Fax:

E-Mail: Website:

Average Number of Employees: Type of Business:

Certifications (SBA 8(a), Regional Purchasing Council, etc.):

Do you export? Yes No

Products or services? From: To:

Principal Clients:

Is your firm a Hispanic Business Enterprise ? (at least 51% Hispanic owned and operated) Yes No

Please attach a brief corporate profile, including a company history and a description of your products/services

 MEMBERSHIP CATEGORIES

 Please indicate your membership category:  

1-10 Employees ………………………………….…………………………..............$120.00