Pi’ilani Membership Application Form

Please fill out below for new and renewal memberships

Directions:

Please fill out the application. The blue tinted fields are required. The gray areas are optional.

When finished, click CONTINUE. Your information will be sent to us, and you will be directed to where you may select your appropriate membership option.

Note: If you click the CONTINUE button and it does not move forward, please confirm that you have filled in all the fields appropriately.

Membership Application

Membership Membership New Membership Renewal

Applican Name #1

Ancestry #1 Ancestry #1 Hawaiian Ancestry

Date of Birth #1 (MM/YY)

Phone #1

Email #1

Address (Street, City, Zip)

Applicant Name #2

Ancestry Ancestry Hawaiian Ancestry

Date of Birth #2 (MM/YY)

Phone #2

Email #2

Household Member 1 (Name, DOB)

Household Member 2 (Name, DOB)

Household Member 3 (Name, DOB)

Household Member 4 (Name, DOB)

Household Member 5 (Name, DOB)

Household Member 6 (Name, DOB)

Household Member 7 (Name, DOB)

Household Member 8 (Name, DOB)

Please help out. Check events that you can kokua (help) within PHCCOC Please help out. Check events that you can kokua (help) within PHCCOC Golf Tournament ( 25-August ) - 6:00am to Noon Golf Tournament ( 25-August ) - Noon to Clean-up Ho'olaulale'a - ( 2-September ) - 7:00am - Noon Ho'olaulale'a - ( 2-September ) - Noon - Clean-up Website/Internet Support

Message

14 + 7 =