H.O.W Membership Application

Please complete and submit the form with the required information. The Association reserve the right to accept or decline membership to any applicant.

First Name Last Name
Address Apt. No.
City State Zip Code
Home Phone Cell Phone
Primary E-mail
Secondary E-mail
I prefer to be contacted by? (check one) Phone E-Mail Mail
Do you belong to any other non-profit organization? Yes No
If yes, name the organization and current status and function?

Title (Student, Homemaker, Engineer, etc.)
What is your approximate age?





Check interested committees to join/service you can provide:
Fund Raising Committee
Financial  Committee
Public Relations  Committee
Executive  Committee
Graphic Arts
Do you have a special ?
What do you find most rewarding about volunteering?
Personal satisfaction
Public recognition of doing good deeds
Appreciation expressed by those you help
About how many hours can you volunteer?
Volunteering logistics – Preferred duration/frequency of volunteer work
Hours per week
Days per month
Days per quarter
Weeks per year
Flexible Weekdays Evenings Weekends Other
Indicate any special skills you have (including medical first-aid training or experience working with children) that could benefit the organization

Do you travel to Haiti? Yes No
Can you attend our monthly meeting Yes  No  usually on the 3rd Sunday of every month?
How did you hear about us?
Name of current member that referred you?