Off-line Membership Application 2020

2020 Membership Application

Due Date for Directory: December 31, 2019
$10 late fee after January 17, 2020

Annual Dues for fiscal year Jan. 1-Dec. 31 are payable beginning Sep. 2019, and must be paid by Dec. 31, 2019, to be included in the 2020 directory.

To pay by cash or check complete and print this form. Bring it to the monthly meeting or mail it together with your check  to:  HCMGA Treasurer, 2003 Pleasant St., Noblesville, IN 46060.   Please do not mail cash.  Dues and application MUST be together.

Membership Application
type: cell, etc.,

Member(s)

Address

City
State
Zip

Application Type

Membership Type
County
State

Fees

Membership
Newsletter
Donation
Late registration

...

If you are an active member would you like to be a mentor for an intern?

Mentors

Select as many meetings as you would like to bring refreshments:
(You may record 1 volunteer hour in a calendar year when you bring refreshments.)

Refreshments

Learning: List suggestions for speakers, programs, and/or activities

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For internal use only: Background check verified: _______ Membership database entry: __________