Membership Form

MEMBERSHIP FORM

Identify yourself by completing the basic information and provide additional information to update your membership record. Click the SUBMIT link to proceed to the dues payment form. You will then be given an option to pay by check or by payment card. HMAUS accepts MasterCard and VISA payment cards.

PRIMARY MEMBER INFORMATION

* Last Name

* First Name

* Email

* Street Address

* City

* State

* Zip Code

Home Phone

Work Phone

Other Phone

Occupation

ADDITIONAL FAMILY MEMBER INFORMATION

Additional Name

Relationship

Additional Occupation

OTHER INFORMATION

Referred By

Need Help With

Will Help with Activites

* Enter Blue Verify Code

Comments

To complete your membership application and to submit your dues payment with a debit or credit card click on the "SUBMIT" link