Membership Application Form

Associate: Non-manufacturer

Please type or clearly print all information. Return forms to address above with membership dues payment (checks payable to HFMA).

Company Legal Name: ___________________________________________________________________

AKA or DBA: ___________________________________________________________________________

Address (Street, City, Zipcode): ____________________________________________________________

_____________________________________________________________________________________

Mailing Address (if different from above): _____________________________________________________

_____________________________________________________________________________________

Phone: __________________________________    Fax: ________________________________________

E-mail: __________________________________    Cell: ________________________________________

Website: ______________________________________________________________________________

No. of Employees: _________________________   Year Business Established: ______________________

KEY PERSONNEL

President or Owner: _____________________________________________________________________

HFMA Contact Person, who will receive newsletter and other notices:

Name: _______________________________________________________________________________

Title: _________________________________________________________________________________

Phone: __________________________________    Fax: ________________________________________

E-mail: __________________________________    Cell: ________________________________________

--Please also complete Page 2

HFMA Membership Application - Associate - Page 2

COMPANY NAME:  ____________________________________________________________________

SERVICES AVAILABLE (Please check all categories that apply):

□ Broker                                       □ Advertising                                □ Transportation

□ Equipment                                □ Retailer                                     □ Distributor

□ Warehousing                            □ Wholesaler                               □ Packaging

□ Consultation

□ Supplier: Types of Products: _______________________________________________________

□ Other: Specify: __________________________________________________________________

Membership Agreement

This application is for membership in the Hawaii Food Manufacturers Association. A check in the required amount as invoiced for dues payment is attached. (See enclosed invoice.) As a member, I agree to abide by the by-laws and policies of the association and conditions of membership. I realize that this membership must be renewed annually until cancelled in writing.

Signature: ________________________________________   Date: ______________________________

Print Name:     _________________________________ Title: ____________________________________