This form is for New and Renewal Memberships via Credit Card only.
To pay by check please use the printable form
Please make sure your e-mail address is correct.
You should receive a conformation e-mail within 48 hours,
if not please contact us at

Membership year starts on January 1st and is valid for one year.
Applications for renewal must be completed, signed, and submitted annually prior to December 31st.
Membership will be cancelled January 1st of the following year.
Fees December through May $30.00, June through November $15.00.

Red fields must be completed
New member             Renewal     Membership #
Full Name (first last)
Birth date (MM/dd/YYYY) (optional)
Alias
When used how would you like your name
to appear in the newsletter? 		My full name
My first name & last initial
My alias
Do not print my name
May we use your photo in the newsletter? Yes     No
How would you like to receive your newsletter? E-mail     Print
If you DO NOT want us to send you announcements by e-mail, check this box
New memberships receive a name badge Indicate requested name:

 

Home Phone
Work Phone
Cell Phone
Address:       Street

City
State
Zip
Your E-mail Address:
Name on credit card if different than listed above:

 


By submitting this application I hereby agree to the following:

I, the undersigned, declare that I am of legal age (21 or older). In consideration of HGRA’s acceptance of this membership application and my being a member of HGRA, I hereby agree to protect and lay harmless HGRA from any and all damage, injury or death which may occur to my property or person in preparation for; during; at; or immediately following any function held by/for the benefit of HGRA. I also release HGRA from any and all liabilities whatsoever in regard thereto, whether any cause of action may occur to myself, my executor, my administrator or assigns.

Check this box to indicate that you agree to the above
You can not procede without checking this box.

Double check your entries first
There is no confirmation screen after you click submit


Click the Home button below to cancel