New Membership Application

:

Members Name:

 

Members Name:

Additional Family Members:

Street Address:

City:   State:  ZIP:

 

 

Member 1

Island Name (if any):

Best # to Reach You:

E-Mail:

Birthday:

 

Member 2

Island Name (if any):

Best # to Reach You:

E-Mail:

Birthday:

Favorite Charities:

How did you find us?

I am interested in assisting in the following (check all that apply):

Membership  Charities  Activities & Events  Newsletter  Website Design  Soliciting Merchant Support

Do you have any other skills or resources that you would consider accessing to help the HPHC?

none

 

After clicking on the "Submit Form" you will be taken to the payment screen

We are accepting payments using the PayPal service. You do not have to have a PayPal account to continue.

Credit and Debit Cards are accepted.

A $2 convenience fee will be added to your total.

Dues are not tax deductible as a charitable donations