Name (first and last) or Business Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Is this a family membership
*
Yes
No
List all family member names
Is this a pet membership
*
Yes
No
List pet name(s)
Type of membership
*
New
Renewal
Gift
Gift Recipient Name
First Name
Last Name
Gift Recipient Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please let the recipient of the gift membership know who it came from?
Yes
No
Are you interested in attending monthly meetings?
*
Yes
No
Other
Are you willing to help with HSMC activities?
*
Yes
No
Other
Please list your preferred method of contact
*
May we notify you of meetings and upcoming events via email?
*
Yes
No
Other
Membership Type
*
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( X )
Business Membership-Defender
$
500.00
Business Membership-Guardian
$
250.00
Business Membership-Protector
$
100.00
Lifetime Membership
$
1,000.00
Supporting Membership
$
500.00
Sustaining Membership
$
100.00
Contributing Membership
$
50.00
Family Membership
$
35.00
Individual Membership
$
25.00
Student Membership
$
10.00
Senior Membership
$
10.00
Junior Membership (under 18)
$
5.00
Pet Membership
$
5.00
Total
$
0.00
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