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I, ________________________(print name) hereby most respectfully apply for membership in LULAC, and state that I have read, understand and subscribe to the mission of LULAC, the LULAC code and LULAC Constitution this _____day of __________, 2013 (These items can be found at ___________________________________ Original Signature of Applicant

Applicant’s Name______________________________________________ Home Address _______________________________________________ City _____________________ State _____ Zip _____________________ Cell Phone _________________ Home Phone ______________________ Email _______________________________________________________ We, the undersigned members in good standing of the League of United Latin American Citizens, certify that we personally are acquainted with the above applicant and, to the best of our knowledge and belief, this person is of good moral character and worthy of membership in this body.

Council Member

Council Member

Annual dues: $40.00 due before the end of January, 2013. Make check payable to: LULAC and mail to LULAC, P. O. Box 35544, Phoenix, AZ 85069. *You will be assigned a council, unless you state a preference. We will get the two signatures you need for your “council member” above. *Do you have a specific interest in joining LULAC by a council closest to you, or would you prefer an interest-based council? If so, please circle your interest: Immigration, Civil Rights, Education, Health & Human Services, Veterans, Labor/Worker Rights, Young Adults