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Thank you for your interest in becoming a part of our growing community!!

Please complete this form, print it and mail it with your check to:

HLPT
P.O. Box 30482
Winston-Salem, NC 27130-0482
 
Membership

First Name

Last Name
Address
City

State

Zip

Home Phone

                          Work Phone

Country of origin

 statistical purposes only

Email Address

 
EDUCATION
 		 CULTURAL EXCHANGE AND
AWARENESS
 		 SPECIAL EVENTS
 
Scholarship Committee 

Student Incentive Program
Mentor Program
HLPT Representative at
community events

Hispanic heritage events
HLPT Representative at
Hispanic/Latino forums
Lanterns of Hope Volunteer
Fiesta (September)

Spanish Nite (April)
Hispanic Heritage Month
Events (Sep 15 - Oct 15)
COMMUNITY OUTREACH
 		 ADMINISTRATIVE
ASSISTANCE
 		  
Families in Need/Crises
 Assistance

Dental Clinic Volunteer
Community Care Center  
Volunteer
Financial Contribution

Fundraising
Scholarship Fund
 
 
 
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* You will become an active member as soon as we receive your payment
* You will receive a Membership notification when we have processed your application
* If you have any question in reference to you membership application you can call us at (336) 775-HLPT
(775-4578) or you can send us an e-mail with your questions to hlpt@yahoo.com

 As a member, you make a commitment to "light the path toward multicultural understanding" through
your participation in HLPT events and activities

 Your membership fee is 100% tax deductible. Please keep a copy for your records

HISPANIC LEAGUE OF THE PIEDMONT TRIAD
P.O. Box 30651
Winston-Salem, NC 27130-0651
phone/fax: (336) 775-HLPT (775-4578)

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