Hawaii Island Portuguese Chamber of Commerce
Membership Application
Print this form.
Fill in (print) and mail along with your $35
annual dues to:
Hawaii Island Portuguese Chamber of Commerce
P.O. Box 1839, Hilo, Hawaii 96721
| Applicant's Name: | __________________________________________________ |
| Spouse's Name: | __________________________________________________ |
| Home Address: | __________________________________________________ |
| __________________________________________________ | |
| (Optional) Email Address: | __________________________________________________ |
| Firm Name: | __________________________________________________ |
| Type of Business: | __________________________________________________ |
| Title: | __________________________________________________ |
| Business Address: | __________________________________________________ |
| __________________________________________________ | |
|
Telephone: |
Business:__________________ FAX:____________________ |
| Home: ___________________ Cell:____________________ | |
| Hobbies/Interests: | __________________________________________________ |
| __________________________________________________ | |
|
Send Correspondence To: (Please check only one) |
Home Address _____ Business Address ______ |
|
Email Address _____ |
|
| Applicant's Signature: | ________________________________________ |
| Sponsor: | ________________________________________ |
| Sponsor's Signature: | ________________________________________ |
| Date: | ________________________________________ |