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: __________________________
Qualifications:  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.
___________________________________________________________________________________
__________________________________________________________________________________
_______________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Future Adventure Plans: ______________________________________________________________
_______________________________________________________________________________

Favorite Sports / Hobbies: ______________________________________________________________
_______________________________________________________________________________

Other Club Affiliations:________________________________________________________________
_______________________________________________________________________________
__________________________________________________________________________________
_____________________________________________(continue on separate sheet if necessary)
                                                                                                      
Please mrk X where you would be willing to participate if selected for membership:
 __Do a program; __Help find programs; __Help select meeting locations; 
__Take telephone or email reservations and collect for meals. 
Serve as:  __Treasurer/Asst;  __Secretary/Asst; __Membership Chair/Asst;  __Program Chair/Asst;  __Director on the Board;

Applicant Signature______________________________________________
Sponsor's name / Signature ________________________________________________

 INSTRUCTIONS: Fully complete the Application Form and mail it with a cheque, in the amount of $25, payable to Adventurers' Club to:
    Membership Chair:  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 $37.50 and $20 for enrolled spouse members, $22 for non-resident 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____________________________________