Membership Application

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membership type *

Username*

Password*

Confirm Password*

E-mail Address*

Confirm E-mail Address*

Full Name LEAVE THIS BLANK

First Name*

Last Name*

Address 1

State

Postal Code

Phone*

COMPANY NAME*

Job Titile*

Website

Activity

I/We agree to La Camara collecting relevant information (eg, postal address, telephone number, email, member representative contact name) in relation to the membership. The information collected will only be used for La Camara purposes in accordance with La Camara’s Privacy Policy. A copy of our Privacy Policy is available upon request.

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membership type *

EMAIL Address*

Confirm EMAIL Address*

Company name (tick if not applicable)

Company name

Company industry (tick if not applicable)

Company industry

TITLE*

POSITION

FIRST NAME*

Last Name*

Street or postal address*

Choose your State*

Postal code*

PHONE*

How did you hear about La Camara?*

Reason for joining?

Description of the business

Add colleagues to our mailing list

Disclaimer : Your colleagues will be added to our mailing list to receive invitation to our events and the e-newsletter.

I/We agree to La Camara collecting this relevant information in relation to the membership application. The information collected will only be used for La Camara purposes in accordance with La Camara’s Privacy Policy

Membership Application

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