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membership form

Member Information (please complete the following information)
Organization - Branches
•Hispanic 100 Policy Committee, Inc.–Nonprofit 501(c)4 organization / ID # 27-3129197
•Hispanic 100 Foundation–Nonprofit 501(c)3 organization / ID # 46-1962620
•Hispanic 100–(STATE PAC) / ID # 1247996
•Hispanic 100 Political Action Committee–FED PAC / ID #80-0797560
PLEASE ALLOCATE MY MEMBERSHIP DUES AS FOLLOWS:
Please fill out the following information for credit card payment (Hispanic 100 Policy Committeeand Hispanic 100 Foundationonly).
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