Name…………………………………………………………..…………………………………………………………………

Address……………..…………..…….………………………………………………………….

E-Mail…………………………………………………….     

Phone…………………………………………………….

Place of Birth……………..…………………………………………………………………

Spouse’s name.& Place of Birth……………………………………………………………………………….

Children’s names and ages ……………………………………………………………………………………

Languages spoken…………..………….…………………………………………………………………….

Profession / Trade……………………………………..……………………………………………………….

Employed by………………….……………….…………………………………………………………………..

Hobbies / Interests…………………..………..…………………………………………………………….

Did you learn about the HACC from some of our members?   (Yes/No)…………….……….

If yes, from whom?……………………………………………………………………………………………………………………

If no, how did you find out about us?…………………………………………………………………………………….

Have you attended any of our past events? (Yes/No)……..  If yes, how many?………………

Please choose the committee(s) you or your family members might be interested in helping:    

Arts [  ], Education [  ], Fundraising [  ], Membership [  ], Nominations [  ] , Publications [  ], Social [  ]

Signature………………………………………………………………………..Date…………………..

Annual dues: Singles $ 25.00, Family $ 35.00, Organizations $ 50.00.

New Members: Add a one-time initiation fee $ 10.00.

Total: …………………………..  (Make checks payable to HACC).

Send Membership application with payment to:

HACC. Membership Committee

P.O. Box 25                                                 

New Britain, CT. 06050- 0025