Membership Application Form

Food 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: ______________________

Factory/Plant Information (if different from above):

Address (Street, City, Zipcode): ____________________________________________________________

_____________________________________________________________________________________

Phone: __________________________________    Fax: ________________________________________

KEY PERSONNEL

President or Owner: _____________________________________________________________________

General or Sales Manager: _______________________________________________________________

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 - Food Manufacturer - Page 2

COMPANY NAME:  _____________________________________________________________________

PRODUCTS (Please check all categories that apply):

□ Animal food                              □ Grain & oilseed milling             □ Sugar

□ Seafood                                    □ Bread & bakery product           □ Cookie, cracker, & pasta

□ Tortilla                                       □ Snack food                               □ Coffee & tea

□ Flavoring syrup & concentrate □ Seasoning & dressing              □ All other miscellaneous food

□ Soft drink                                  □ Bottled water                            □ Breweries

□ Chocolate & confectionery from cacao beans                              □ Nonchocolate confectionery

□ Confectionery from purchased chocolate                                     □ Frozen fruit, juice & vegetable

□ Frozen specialty food               □ Fruit & vegetable canning, pickling & drying

□ Dairy product                            □ Animal slaughtering & processing

□ Wineries                                   □ Distilleries

MARKET AREAS (Please check all that apply):

□ On-island                                  □ Other Hawaii Islands                □ West Coast U.S.

□ Central U.S.                              □ East Coast U.S.                       □ Canada

□ Japan                                        □ Asia                                          □ Pacific

□ South or Central America        □ Europe                                      □ Australia/New Zealand

□ Other (please specify:) _________________________________________________________________

CURRENTLY AVAILABLE LOCALLY AT (Please list the top five locations where your product is sold.)

_____________________________________________________________________________________

_____________________________________________________________________________________

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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. I certify that the products that are covered by this membership are manufactured by my company and are at least 51% wholesale value added in the State of Hawaii.

Signature: ________________________________________   Date: ______________________________

Print Name:     _________________________________ Title: ____________________________________