This document is a membership application for Latinos Unidos del Norte, a non-profit organization based in Fairbanks, Alaska that has supported education and created bonds of friendship since 1981. The application collects contact and payment information for a $12 individual or $20 family yearly membership, lists interest areas, and provides a receipt upon approval of dues until the next June renewal date.

1. P.O. Box 74795
Fairbanks, Alaska 99707
“Creating Bonds of Friendship and Supporting Education Since 1981”
MEMBERSHIP APPLICATION
Name: ____________________________________________________________________
Address: __________________________________________________________________
Email Adress: ______________________________________________________________
Telephone: ____________________________ Country / Culture: ____________________
Membership is $12.00 per person or $20.00 per family.
Both memberships are good for a year and are due for renewal in the month of June
List of activities in which your are interested:
Social activities/events ______ Cultural activities/events _____
Other: ______________________________________________________________________
Signature: ______________________________ Date: _________________________
Form of payment: ________________________
Latinos Unidos del Norte is a non-profit organization. All the information here is strictly
confidential.
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Member’s Receipt
Received from_______________________________________________________________
Club dues are paid until________________ Approved by: _________________________