HACC/ CHAC Membership Application
Name....................................................................……………………...................................................
Address.................…………..…….……………………………………………….............
E-Mail.................................……………….......... Phone.............................................................
Place of Birth.................……………………............………….......................................................
Spouse’s name.& Place of Birth………………………….............................................................
Children’s names and ages ..................………….........…………………....................................
Languages spoken..............…….......………………………………...........................................
Profession / Trade........................…………........……………………….....................................
Employed by......................………..........…………………………...............................................
Hobbies / Interests.......................…….....………………………………..................................
Did you learn about the HACC from some of our members? (Yes/No)…………….…...
If yes, from whom?....................................................................................................................................
If no, how did you find out about us?.................................................................................................
Have you attended any of our past events? (Yes/No)…….. If yes, how many?..................
Please choose the committee(s) you or your family members might be interested in helping:
Arts [ ], Education [ ], Fundraising [ ], Membership [ ], Nominations [ ] , Publications [ ], Social [ ]
Signature..........................................…………………………………..Date.......................
Annual dues: Singles $ 25.00, Family $ 35.00, Organizations $ 50.00.
New Members: Add a one-time initiation fee $ 10.00.
Total: ................................ (Make checks payable to HACC).
Send Membership application with payment to:
HACC. Membership Committee
P.O. Box 25
New Britain, CT. 06050- 0025
