EBHQ 2018-19 Membership Form
Please use this form to apply for a new membership or to renew your existing membership. Our dues year runs from July 1 through June 30 of each year. Direct any questions to ebhqmembership@gmail.com.

EBHQ Privacy Information: We print a directory with member names and contact information every 2 years. This directory is available only to members, including our retail affiliates. Please indicate if you do NOT want any of your contact information released in the directory.

First Name *
Your answer
Last Name *
Your answer
Status of membership *
New members, can we list your name and city in our monthly newsletter?
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone-give the one best to reach you at. (xxx) xxx-xxxx *
Your answer
Email address
Your answer
Your answer
Release of Contact Information
If you only want some parts of your contact information printed in the directory, please specify those field that you DO NOT want printed.
Membership prices
Individual is $45 per year; Family is $55 per year; Retail Affiliate is $50 per year.
Type of Membership *
Term of Membership *
If family was chosen, provide names of included family members.
Your answer
Tax Deductible Donation
If you would like to further support and expand the activities of EBHQ by making a tax deductible donation, please indicate the dollar amount of your donation below. To pay by credit card, scroll to the bottom of the payment options page. To pay by check, add your donation amount to your membership amount and write one check.
Donation amount
Your answer
Payment Method *
Volunteer Survey
EBHQ is an all volunteer organization and relies on its members to volunteer for a wide variety of tasks. Please indicate below the task(s) you could help with.
Volunteer choices *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service