URLThis field is for validation purposes and should be left unchanged.Central Colorado Humanists Membership Registration Form A. Information about person completing this form (bold* = required)First Name*Last Name*Preferred First Name (for nametag)Email*Primary mailing address*Primary mailing city*Zip*State*Local address (if different)Primary phoneAlternate phoneB. Membership and donation info. Note: Membership fees and donations given to CCH, a 501(c)(3) organization, are tax-deductible to the extent allowed by law. Type of membership – (‘Benefactor’ includes ‘Household’)Membership Level*Select Membership Level – (click on the arrow to see menu of membership levels then click on the one desired)Individual Membership – One-year $40Individual Membership – Two-year $80Individual Membership – Three-year $120Household Membership – One-year $70Household Membership – Two-year $140Household Membership – Three-year $210Benefactor Membership – One-year $300Benefactor Membership – Two-year $600Benefactor Membership – Three-year $900Student Membership – One-year $15Payment Method*If you select the PayPal payment option, you will see a PayPal button at the bottom of the form which will submit your info and allow you to payPayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number xxxx-xxxx Expiration Date MM/YY Security Code CVV C. For household/benefactor membership only. Spouse/Partner First Name *Spouse/Partner Last Name *Preferred First Name (for nametag)Email *Primary phoneAdditional household members:D. For student membership only. Name of school where enrolledE. Volunteer opportunities Please consider how you might be able to help the organization grow and prosper, and then check any places where you could contribute. I would be willing to serve on the CCH board of directors:Person completing this form Yes No I would be willing to serve on the CCH board of directors:Spouse or partner (household or benefactor only) Yes No I am willing to help with the following CCH committees:Person completing this form. Check all that apply. Audio/Visual Book Club CCH History/Archives Communications Community Outreach Finance & Budget Hospitality/Greeters K-12 STEM Mini-grants Membership Non-Traditional Student Education Grants Personal Hygiene Product Distribution Scholarships Social Sunday Brunch and Discussion Group Sunday Science Programs Sunday Science Refreshments Website Maintenance I am willing to help with the following CCH committees:Spouse or partner (household or benefactor only). Check all that apply. Audio/Visual Book Club CCH History/Archives Communications Community Outreach Finance & Budget Hospitality/Greeters K-12 STEM Mini-grants Membership Non-Traditional Student Education Grants Personal Hygiene Product Distribution Scholarships Social Sunday Brunch and Discussion Group Sunday Science Programs Sunday Science Refreshments Website Maintenance F. Please list any special skills (e.g. Sunday Science speaker, Accounting, IT or audio/video expertise, etc) that you (and/or your partner) have that could benefit our organization. F. Please list any special skills (e.g. Sunday Science speaker, Accounting, IT or audio/video expertise, etc) that you (and/or your partner) have that could benefit our organization. G. Anything else we should know? Professional background? Special interests? Suggestions?G. Anything else we should know? Professional background? Special interests? Suggestions? CCH is required to periodically share basic contact info for our members with the American Humanist Association to maintain our status as a ‘chapter’ of the AHA. Completing this form grants us permission to do so, but beyond that we won’t share any of your personal information without your explicit permission.UntitledFirst ChoiceSecond ChoiceThird Choice
