MEMBERSHIP APPLICATION Maui Portuguese Cultural Club P.O. Box 4035, Kahului, HI 96733 APPLICATION FOR MEMBERSHIP DATE ________________ NAME______________________________________________ MAILING ADDRESS_________________________________________________ _________________________________________________ E-MAIL ADDRESS _________________________ TELEPHONE: HOME _____________________ CELL _________________________ WORK _____________ DATE OF BIRTH ______________ PLACE OF BIRTH _____________________________ U.S. CITIZEN? YES ___________ NO ____________ ETHNIC BACKGROUND _____________________________________________________________________ Print form. Complete with information then mail to: Maui Portuguese Cultural Club, P.O.Box 4035, Kahului, HI 96733. MEMBERSHIP DUES ARE $25.00 PER ADULT PER YEAR AND $10.00 FOR INDIVIDUALS UNDER THE AGE OF 18 YEARS OLD. DUES ARE PAYABLE UPON COMPLETION OF THIS FORM AND EACH YEAR BY NOVEMBER 30th, THEREAFTER.
