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Membership Dues

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Member Dues Statement Summary:
Transaction Date: 11/22/17
*Insert Quantity in the Boxes Below & not "$" amount. *ONE FORM PER MEMBER
 
Regular Dues +GLSA - $332.50:
Life Dues +GLSA - $47.50:
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:
Pre-assigned Men's Locker w Key Card - $80:
Pre-assigned Tall Locker w Key Card - $140:
Men's Locker Access Only Key Card - $30:
Pre-assigned Women's Locker w Key Card - $80:
Women's Locker Access Only Key Card - $30:
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
www.elkslodge616.org