Puerto Rican Society, Inc.

Puerto Rican Society, Inc.
P.O. Box 6351
Chesterfield, MO 63006
http://www.sprstlouis.com

Membership Application Form

Name (Nombre):

E-Mail (Correo Electronico):

Phone (Telefonos):

Residential Address (Direccion Residencial):

City (Cuidad):

State (Estado):

Zip Code
(Codigo Postal):

Work Information (Informacion del Trabajo)

Brief Description (Description Breve)

Personal Information (Informacion Personal)

Why do you want to become a member of this society? (?Por que quiere pertenecer a esta sociedad?)

Personal References (Referencias Personales)

I, , formally apply for membership in the Puerto Rican Society, Inc. (Solicito formalmente ser socio de la Sociedad Puertorriquena.)

One-time Initiation Fee (cuota de iniciacion): $25.00

Types of Membership and Annual Dues
(Clases de Socio y Cuotas Anuales):

	Student (Estudiante) $5.00
	Family (Familia) $20.00
	Adult (Adulto) $15.00
	Senior (Envejeciente) $10.00

Checks should be mailed to:
PUERTO RICAN SOCIETY, INC.
P.O. Box 6351
St. Louis, MO 63006-6351

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Puerto Rican Society, Inc. P.O. Box 6351, St. Louis, MO 63006-6351
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