(A couple is two adults / friends sharing one address)
Application for: NEW ( ) RENEWAL ( ) COMBINATION - New & Renewal ( )
Name of First Member: _______________________________________
Name of Second Member:_______________________________________
Phone Number:______________ Email Address:____________________
Please complete below, even if address is the same.
Address: Street,P.O.Box,Rural Route etc.__________________________________ Apt.#_____
City, Town, Village:__________________________ State:__________ Zip Code:___________
New Members: I heard about HAGS through:____________________________________________
** Your membership cards will be mailed shortly after your application is received, if you have any questions, please call Carlene Starace 561-809-6409. No Refunds.
Check form for accuracy, Print, enclose your check along with the application and mail to:
H.A.G.S. c/o Starace 6065 Verde Trail S. Apt. G116
Boca Raton, Fl. 33433