Application Form - copy this form and paste it on a blank document to print

THE ADVENTURERS' CLUB OF HONOLULU
Application for Membership

Full Name and Title ____________________________________  Date:___________

Home Address ________________________________________________________

Phone_______________________________________      Fax___________________

e-mail_______________________________________
Year of Birth (optional) ___________  Place of Birth: ____________________
Occupation: ____________________  Education: _______________________
Name of Spouse: _________________Are you applying for a couple's membership? ____
      The Club was organized to promote adventure and knowledge of the sciences, arts, and humanities among those who have left the beaten path and sought knowledge and adventure.
       Please list your adventure/travel history and furnish information or special knowledge
that will further your claim.  Attach additional sheet if necessary.
___________________________________________________________________________________
__________________________________________________________________________________
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__________________________________________________________________________________
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Future Adventure Plans: ______________________________________________________________
_______________________________________________________________________________

Favorite Sports / Hobbies: ______________________________________________________________
_______________________________________________________________________________

Other Club Affiliations:________________________________________________________________
_______________________________________________________________________________
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_____________________________________________(continue on separate sheet if necessary)
                                                                                                      
If selected for membership I would be willing to:  __Do a program; __Help find programs;
__Help select meeting locations;    Serve as one of the following:  __Treasurer/Asst;
__Secretary/Asst; __Membership Chair/Asst;  __Program Chair/Asst;  __Director on the Board;
__Take telephone reservations and collect for meals.

Applicant Signature______________________________________________
Sponsor's name  ________________________________________________

   INSTRUCTIONS: : Fully complete the application and check for the Initiation Fee, in the amount of $25, payable to Adventurers' Club.     Mail application form and check to:
                             Janet M. Miller, 2665 Peter Street, Honolulu, HI 96816-2013
                                          (phone:  808.732.3506         email:  miller@hi808.us)
You are welcome to attend meetings while your application is being processed. Annual dues are $35, and $17.50 for enrolled spouse members, $20.00 for off-island members. First year dues are prorated at $3.00 per month if application is approved after January.  Once approved, you will be billed for your annual dues.
Official use only:
Membership Chair's Signature__________________________________   Member No. ______
President's Signature____________________________________