Get Involved

Become a Member

Please fill out our form below to become a member of Latina PAC online.
If you prefer to mail us the application with payment please click here.

First Name: Last Name:

Mailing Address :
(including apt#)

City: State: Zip Code:

Home Telephone: Mobile Phone:

E-mail Address:

Are you eligible to vote? Are you a registered voter?

Did you vote in the last election?

What is your racial-ethnic background?

If Latina, please specify Latina/o ethnic origin:
(i.e., Puerto Rican, Dominican, Colombian, etc)

Currently a Student? If so Name of School:

Indicate major professional or career field:
(please select only one)

If other please specify:

What is your highest educational degree completed?

Major Field of this degree?

Membership Type:
Please select membership type:

*Once the form is submitted, payment can be made on the next page.