Membership Application
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Individual Membership •  Dues $25/Year             *               Student Membership•  Dues $15/Year
Organizational Membership • Active Dues $50/Year
Corporate Sponsor •  Dues $250/Year

Name: Individual or Student____________________________________________________________

Mailing Address _____________________________________________________________________

City/State/Zip Code__________________________________________________________

Home Phone ( ___ )______________________ Email ______________@______________________

Remember that e-mail is case sensitive, so please print carefully.

Organization ________________________________________________________________________

President or Director   ________________________________________________________________

Mailing Address _____________________________________________________________________

City/State/Zip Code__________________________________________________________

Phone ( ___ )_________________________ E-Mail ______________@________________________

Name of Representative to NWHP   _____________________________________________________

Remember that e-mail is case sensitive, so please print carefully.

Make a Donation to NHWP  - $___________________ Amount sent