MEMORIA, VOZ, Y PATRIMONIO:
The First Conference on Latino/Hispanic Film, Print and Sound Archives

The Sixth Institute of the Trejo Foster Foundation for Hispanic Library Education
August 15-17, 2003; University of California, Los Angeles
http://www.gseis.ucla.edu/LAConf/

 

Print this form and mail to: Latino Archives Donation,
UCLA Dept. of Information Studies,
210 GSE&IS Building,
Box 951520, Los Angeles, CA 90095-1520,
or
fax to: 310-206-4460

DONATION FORM

Name: ____________________________________________________________________________________
Organization:______________________________________________________________________________
Address:_________________________________________________________________________________
City:______________________________________State:___________________Zip:____________________
Phone:_____________________________Email:_____________________________________

Donation Categories:

___________SOCIO $25-$99

SOCIO sponsor names will be included on the conference website.

___________AMIGO $100-$249

AMIGO sponsors will receive in addition to the above level, their names printed in the conference program.

___________INSPIRACIÓN $250-$499

INSPIRACIÓN sponsors will receive in addition to the above levels, a ribbon to wear on their conference badges that designate sponsorship status.

___________CORAZÓN $500-$999

CORAZÓN sponsors will receive in addition to the above levels, a "Certificate of Recognition" during the conference.

___________ OTHER $____________

Donations in other amounts are appreciated and will be recognized.

Payment method:
  ___ Check payable to UCLA Foundation (Preferred method of payment)
Credit card:   __ VISA       __ MasterCard 

Expiration date: ___________________

Cardholder name:  _______________________________

Signature: ______________________________________