LVEJO Membership Form
One Year Membership:  Chile Habanero: $50 and up: Non-for-profit / Business Membership |  Chile Piquín: $25 |  Chile Jalapeño: $10 | Chile Guajillo: $5 

Membership Information: 

Date:_________________________

Individual: _____ Family: ______

Name: __________________________________________________

Address:_________________________________________________

City: _________________ State: _______ Zip Code: __________________

Tele: (_____) _______________ Cell: (____) _________________ Email: ______________________________

Work Place: ____________________________________________

Work Tele: (_____) _______________________ Email: ____________________________________________
 

I Can Volunteer: 

Day: ______________ _______________ ______________ _________________

Hours: From: _____________ to _______________

Talents/Skills: ______________________________________________________________________________

___________________________________________________________________________________________

2856 South Millard Ave.
Chicago, IL 60623
773/762-6991

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