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.
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First Name *
Last Name *
Status of membership *
New members, can we list your name and city in our monthly newsletter?
Clear selection
Street address *
City *
State *
Zip Code *
Telephone-give the one best to reach you at.  (xxx) xxx-xxxx *
Email address
Website
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.
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
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 *
Required
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