Casa Pacifica Amigos Membership

Amigos Membership Fee

To make a donation of any amount in lieu of membership please use the last field.

Fee

Individual Amigo Membership

$ 50.00

Amigo Family (up to 5 members)

$ 150.00

$250 Amigo Event Sponsorship

$ 250.00

$500 Amigo Event Sponsorship

$ 500.00

$750 Amigo Event Sponsorship

$ 750.00

$1,000 Amigo Event Sponsorship

$ 1,000.00

Other amount

Amigos Application Information

Please check the boxes that you wish to participate in:

Comments:

Amigos Committee:

Amigos Team Days / On Campus Events:

Carnival:

Include Name in Directory?:

On Campus Volunteer Mentor:

Referred By:

Sponsor A Child:

Can't volunteer time / Donation only:

Wet N Wild Water Day:

Winter Dance:

How Did You Hear About Our Site:

Billing Information

Title:

First name:

Middle name:

Last name:

Country:

Address lines:

City:

State:

ZIP:

Phone:

Email:

Payment Information

Cardholder's Name:

Credit Card Number:

Card Type:

Card Expiration:

Card Security Code: