HCA Member Application Form

Haitian Community Alliance

Member Application Form
Thank you for your interest in joining the Haitian Community Alliance (HCA). Please complete this form to apply for membership or partnership. By becoming a member, you join a growing network of organizations committed to supporting the Haitian community in Springfield, Ohio.
Your Name*

PrefixFirst NameLast Name
Birth Date*

MonthDayYear
Email*
example@example.com
Your Profession:
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Involvement
Please select one:*

Supporter: Organizations or individuals who align with our mission and offer their backing through donations, advocacy, or resource sharing without formal commitment.Individual Member: Individuals who actively participate in our nonprofit, contributing to its growth and decision-making while benefiting from exclusive membership opportunities.Organization Member: Organizations that officially join our nonprofit, engaging in activities, contributing to our mission, and having a voice in strategic initiatives. (Annual contrOfficial Partner: External organizations that collaborate closely with us on specific projects or initiatives, bringing expertise and resources to help achieve shared goals.
Your organization's name:(if apply)
Your Position: (if apply)
Why Do You Want to Join HCA? Please briefly explain why your organization wants to join the Haitian Community Alliance and how you hope to contribute to our mission.
Annual Membership Contribution for

Please note that your membership contribution will be due after our first official assembly, where we will discuss our plans, goals, and the responsibilities of our members. We kindly ask that all contributions be submitted following the assembly to ensure that your membership remains active and in good standing. Details regarding the payment process will be provided during the assembly.
If you have any questions, feel free to contact us at:

Email: info@haitiancommunityalliance.org
Phone: (844) 422-2139

Thank you for your commitment to our cause!
Date*

MonthDayYear
Date
Signature*

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Haitian Community Alliance

Type of Involvement

Annual Membership Contribution for