NY CHUMS Membership Form

Membership Application
CHUMS, Inc. is a non-profit organization that provides opportunities for women to meet in friendship and fun, to encourage a spirit of helpfulness, and to use their many talents in service to the community.

We promote civic, cultural, educational, and social improvement. An ancillary focus of the organization is to enrich the lives of children by helping them to develop to their fullest intellectual, moral, emotional, physical, and social potential.

Our National Theme
The national theme is "Listen to the Children…enrich their lives".
Interest Contact Information:
Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
E-mail
example@example.com

Tell us more about yourself:
Age Range
Birthday

MonthDayYear
Marital Status

MarriedSingleDivorcedWidowed
Wedding Anniversary Date
Educational Background
High School
College
Graduate
Awards

Professional Background
Industry
Position Title
Occupation / Profession
Professional / Achievements
Professional / Certifications
Organizations / Club Affiliations
Hobbies

Interest Information
Strengths you will bring to the CHUMS:
Should be Empty: