CHGPA Membership Information Form

This form may be used by both new and renewing CHGPA members to provide contact information which is used to maintain the club's membership roster. The roster helps us preserve our chapter status with the USHPA, and allows our members to stay in touch with each other. So please keep your information up-to-date, it really will help us out!

New CHGPA members: Please complete this Membership Information form first, providing all of your contact information. Then, use the separate CHGPA Dues Payment Form to pay your club membership fee. We don't accept on-line payments at this time, so please fill out the requested information on the dues-payment form, print it from your web browser, and then mail the form and your check to the address included on the form. Thanks very much!

Renewing CHGPA members: You do not have to use this form for most renewals. The CHGPA Dues Payment Form includes a free-text 'Membership Information Changes' section, which can be used if you need to make minor corrections to your roster information: a new email address; a new phone number; etc. However, if your information has changed significantly, then feel free to use this more complete and structured form instead. But be aware that you will have to provide all of the required form fields, even if you just want to make a minor change.

We also accept hard-copy versions of this form : Simply enter all the requested information, use your web browser to print out the completed form, and then send it to the CHGPA Treasurer. But if at all possible, please complete this form and send your membership information to us on-line, by hitting the Submit button at the bottom of the page. Thanks very much!

Required membership information is flagged with red asterisks.

First Name: *
Last Name: *
Address: *
City, State: * ,
Zip Code: * - (please use zip+4 if known)
 
Home Phone: * Work Phone:
Cell Phone:
E-mail address: *
CHGPA Forum username: (if you have already registered)
 
Emergency contact name: *
Emergency contact phone: *
 
USHPA #    Expires:    (mm/dd/yyyy)
 
HG Ratings:    Observer: () Yes    () No
      Wings:
 
PG Ratings:    Observer: () Yes    () No
      Wings:
 
HAM Call Sign:

Exclude me from the members-only online roster at the club website: Yes No

Comments or Special Instructions:




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