PLAZA LAS AMERICAS MALL WALKERS
MEMBER DIRECTORY
We kindly request that you fill out the information required in the spaces below and
return it at your earliest convenience, with the purpose of creating a Member Directory
of Plaza Las Americas’ mall walkers “Caminantes de Plaza”.
Name:____________________________________________ID Number:________
Residential Address:_____________________________________________________
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Telephone Number:_________________ Birthday: Month _____ Day _____
Marital Status: ______________________ Wedding Anniversary: Month_____Day_____
Person to notify in case of Emergency:____________________________________
Address and Phone Number: _______________________________________________
_______________________________________________________________________
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Signature
Photo
______________________________
Date of Enrollment