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How To Join

Download below the membership application in its PDF format. Complete and fax to HACIA at (312) 575-0544 or email back to Maria Mercedes Esparza Mesparza@haciaworks.org. Or complete the online form.

HACIA Membership Application 2017

 

Fields marked with an * are required

ex. 555-555-5555

For the purpose of representation one membership designee is conferred to company. This member will serve as its voting member and will be responsible for upholding membership responsibilities.

MBE CERTIFICATIONS

EXPIRES

WBE CERTIFICATIONS

EXPIRES

OTHER CERTIFICATIONS

EXPIRES

Membership Category (check one):

  • At least 51% Hispanic owned and managed
  • MBE/WBE/DBE certified. Current certification(s) must be submitted with this application
  • Any M/W/DBE less than 51% Hispanic owned and managed.
  • Gross volume in excess of $20,000,000+

Annual Membership Dues: Total volume is defined as last year’s annual gross revenues.

Annual Membership Dues: Total volume of your 2016 annual
gross revenue

Check Appropriate Box
below for your Dues Rate

Payment either by check payable to HACIA or include credit card information below.

If paying by Check, please send checks to HACIA at 650 W. Lake St. Suite 415 Chicago, IL 60661.

You can upload the attachments for the firm’s current certification letter and any supporting documentation

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