CAH: MEMBERSHIP PROMOTION FOR 2019-2020

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:

• If you choose payment via check, send it to: Casa Argentina de Houston, 4740 Ingersoll, Suite 104, Houston TX 77027

• Si escoge la opcion Familia, por favor incluya los nombres de la pareja e hijos menores de 18 años aqui. If you choose the Family option, please include the name of the couple and children up to 18 years old here.

• Si desea colaborar o ser parte de alguna de las comisiones, indique su preferencia. If you wish to be in any of the committees, indicate your preference.

  • Cultura
  • Deportes
  • Difusion (website, social media, other)
  • Fiestas
  • Socios
  • Solidaridad
  • Jovenes

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Estudiante / Student	$20.00
  Individual	$40.00
  Familia / Family	$65.00
  Benefactor	$130.00
  Circulo de Bronce/ Bronze	$250.00
  Circulo de Plata / Silver	$500.00
  Circulo de Oro / Gold	$1,000.00
  Circulo de Platino / Platinum	$2,500.00
  Platino Premier	$5,000.00
  Circulo Diamante / Diamond	$10,000.00
  Circulo Diamante Premier	$20,000.00

Information

• * Nos gustaría conocerlo mejor. Cuéntenos sobre usted, su trabajo, habilidades, pasatiempos, objetivos, familia, etc./ We would like to know you better. Tell us about yourself, your work, skills, hobbies, goals, family, etc.
   characters remaining
• * Fecha de Nacimiento/ Date of Birth
• Comentarios / Comments

Additional Members Information

You may add a maximum of 20

Business Information

• La afiliación a CAH es válida desde el 12 de septiembre, 2019 hasta el 31 de diciembre 2020. CAH Membership is valid from September 12, 2019 to December 31st, 2020.