HAWAII ISLAND PORTUGUESE
CHAMBER OF COMMERCE
P.O. BOX 1839 - HILO, HAWAII 96720
Established 1982

Membership Application

Print this form.  Fill in and mail along with your $35 annual dues to:

Hawaii Island Portuguese Chamber of Commerce
P.O. Box 1839, Hilo, Hawaii 96721

	(Please type or print)
Applicant's Name:	________________________________________
Spouse's Name:	________________________________________
Home Address:	________________________________________
	________________________________________
	________________________________________
Email Address:	________________________________________
Firm Name:	________________________________________
Type of Business:	________________________________________
Title:	________________________________________
Business Address:	________________________________________
	________________________________________
	________________________________________
	Telephone:
Business/FAX	___________________ /____________________
Home/Cell	___________________ /____________________
Hobbies/Interests:	________________________________________
	________________________________________
	________________________________________
Send Correspondence To:	Home Address _____  Business Address ______
	Email Address _____
Applicant's Signature:	________________________________________
Sponsor:	________________________________________
Sponsor's Signature:	________________________________________
Date:	________________________________________