New Member Registration


Step One:


Please fill out the following form if you are a first time member. If you are not a first time member, please close this window and fill out the returning members registration forms.


First Name*: A value is required.
Last Name*: A value is required.
Email*: A value is required.
Contact Phone*: A value is required.
Address Line 1*: A value is required.
Address Line 2:
City*: A value is required.
State*:
Zip Code*: A value is required.
 
Career and Employment Information: past and present/volunteer and paid*:
A value is required.
Formal Education: Names of institutions, dates attended, degree or certificates*:
A value is required.
Informal education, hobbies, educational travel*:
A value is required.
What subjects would you like to explore*:
A value is required.
 
Would you like to contribute:
(check all that apply)		   Help With Mailings
  Membership Recruitment
  Curriculum Planning
  Marketing and Publicity
  Planning Social Events
  Lead a Group
  If so, which:  
 
How did you hear about us:
(check all that apply)		   Catalogue
  Poster
  Ad
  Friend
  BHS Event
  Website
  Other:  
 
 
First Seminar Choice*: A value is required.
Second Seminar Choice*: A value is required.
Third Seminar Choice*: A value is required.
Alternate Choice*: A value is required.