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Membership Dues

Secure Payment Form

Member Dues Statement Summary:
Transaction Date: 04/19/18
*Insert Quantity in the Boxes Below & not "$" amount. *ONE FORM PER MEMBER
Regular Dues +GLSA - $333.50:
Life Dues +GLSA - $48.50:
Elks Lodge National Foundation-Optional - $25:
Major Project Purple Pig-Optional- $25:
Scholarship for Hawaii students-Optional $25:
Youth Ocean Sports Training Optional - $25:
First Parking Decal - $50:
Second Parking Decal - $75:
Men's Locker Room Entry Key Card - $90:
Women's Locker Room Entry Key Card - $90:
Fitness Room Entry Key Card - $150:
Pre Assigned Surf Board Rack - Regular Size - $180:
Pre Assigned Surf Board Rack - Large Size - $240:
Pre Assigned Canoe Rack - $300:
Total Charge $:
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
[What is the Card ID?]
Member Information:
Member Number:
Member First Name:
Member Last Name:
Phone Number:
Email Address:

Honolulu Lodge 616 BPOE - 2933 Kalakaua Ave Honolulu, HI 96815
For questions or concerns, please call: 808.923.5722