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Membership

If you are interested in becoming a member of The Hispanic Empowerment Association of Roseville (H.E.A.R.), please complete the form below:

 

First Name

 

 
Last Name

 

 
Address

 

 
City

 

 
Phone #

 

 
Email Address

 

 
How did you hear about us?

 

 

Please fax your application to (916) 782-2040 or mail to:

H.E.A.R

136 Donner Avenue

Roseville, CA 95678