Heartland Spiritual Alliance – Membership Application 2015 HSA PO Box 300926, Kansas City, MO 64130 Please PRINT Legibly. Membership dues are: $20.00 until January 31, 2015; $30 until February 28, 2015; $40 until March 31, 2014; $50 until April 30, 2015. If paying by check or money order, please make out to HSA To pay with Paypal: Pay July 1 or AFTER. Send the payment to treasurer@kchsa.org. You must put a comment in Paypal that payment is for membership and indicate the member’s legal name as it appears on this form.
Legal Name: __________________________________________________ Preferred Name: _______________________________________________ Mailing Address: _______________________________________________ City: ___________________________ State: __________ Zip: __________ Phone Number: ____________________________ Home / Cell / Work (circle one) Email Address: ________________________________________________ If you do not wish to be listed in a membership directory or online by-name notifications, initial here _________
Every HSA member is required to contribute a minimum of 20 hours of work to one or more of our committees during the festival, or for setup & teardown immediately before or after festival. Please select which committees you wish to work with. To make this choice more convenient for you, the committees are listed below. Please PRINT your choices in order of preference in the places indicated. Please DO NOT check or circle the committee names. Every attempt will be made to assign members to the committee(s) of their choice; however members may be assigned to a committee based on the needs of the organization. First Choice __________________________________________________________________ Second Choice _________________________________________________________________ Third Choice __________________________________________________________________ Community Fires* First Aide* Fundraising/Merchandising Gaea Youth* Hospitality* Information Tech Membership *primary function occurs at festival
Merchants* Public Relations Publications Security* Sacred Experience Site/Sanitation* Speakers & Bands*
Registration/Community Service* Trash/Recycling* Work Exchange* Vehicular Management* Vice President*
I wish to be a member of the Heartland Spiritual Alliance. I am enclosing the annual membership dues and agree to the by-laws and the governing policy of HSA. I also agree to actively participate in one or more of the above Committees as one of the requirements of my membership, and to perform a minimum of 20 hours of active service to HSA during the festival, or during set-up & tear-down of festival in the current membership year. Signature_______________________________ Date __________________
For HSA Officer Use Only Annual membership dues in the amount of $________ received on ____/_____/_____ in the form of _________________________. This membership is good from the date received and expires on June 30 th 2015.