PLEASE NOTE
 

• You will receive a confirmation email upon submission of the online registration.  Please keep for your records/reference
   
• Required items are indicated by an asterix (*). A red screen will appear if any required fields are missed.  Scrolling up on the red screen will indicated missed items to complete.
   
• If paying by check, please submit the form below and select "Paying by Check" where indicated.  Make check payable to LA Opera and send it to:
  
  LA Opera - HLAO Membership
  135 North Grand Avenue
  Los Angeles, CA 90012

This is a	*	New Membership Edit your profile (no payment required) Membership Renewal
Select Heritage Flag		Argentina United States of America Bolivia Brazil Chile Columbia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Honduras Mexico Nicaragua Panama Paraguay Peru Puerto Rico Spain Uruguay United States Venezuela
➤ CONTACT INFORMATION
First Name *
Last Name *
Email Address	*
Phone Number	*
Fax Number
Address
Address 2
City		Zip/Postal
State/Province
Country
➤ MEMBERSHIP LEVEL
Please Select		HLAO Supporter $65 - for one person HLAO Contributor $125 - for two persons HLAO Affiliate $250 - for two persons HLAO Sponsor $700 - for two persons
➤ PAYMENT INFORMATION
I am authorizing a one-time total of
Charge above amount to my Visa AMEX MasterCard Discover
Please charge my total contribution of
in Biannual Quarterly Monthly
installments of
Card Number
Expiration mo/yyyy
I am paying by	Please make check payable to LA Opera. Send it to: HLAO Membership, 135 North Grand Ave., Los Angeles, CA 90012	Check*
*If paying by check, please submit this form and make a check payable to LA Opera. Send it to: LA Opera - HLAO Membership 135 North Grand Avenue Los Angeles, CA 90012
Security Code	*