Membership

HWBC Membership Application

 

Member #1 info (please print information legibly)                             DATE:

Name:

Address:

City:

State

Zip Code

Telephone: Home

Work:

Cell:

Email:

Birthday: Month/Day                                                                                         New                         Renewal

MEMBER # 2 INFO (if address/phone same as # 1, print “same”)

Name:

Address:

City::

State

Zip Code:

Telephone: Home:

Work:

Cell:

Email:

Birthday: (Month/Day)                                                                                      New                           Renewal

Please make your check payable to: HWBC

Bring to a meeting or mail your completed form with payment to:

HWBC Membership P.O. Box 273, Hartford, CT 06141

FOR BOOSTER CLUB USE ONLY:

MEMBER #1

MEMBER #2

Membership No.

 

 

Cash/Check/Money Order

 

 

Check #

 

 

Date Paid & Amount

 

 

Assigned by

 

 

$10 per member (US funds only)

 Membership is from September 1st through August 31st.