Huntington Beach Coordinating Council

HUNTINGTON BEACH COORDINATIN COUNCIL

2011-2012 APPLICATION

(Please print, complete and mail.)

Organization Name: ____________________________

Street:_________________________________

City:    _________________________________

ZIP:      _________________________________

Phone: _________________________________

Website: ________________________________ 

President's Name: _______________________

Delegate's Name:  _______________________

Delegate Phone: ______________________

Delegate Email: ______________________

Alternate Delegate:____________________

Alternate Email: ______________________

Organization Mission, Goals or Activities:

____________________________________________

____________________________________________

____________________________________________

____________________________________________

Please Mail Completed Application with the $15 Annual Dues to:

HBCC

Box 2304

Huntington Beach, CA 92647

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To assure inclusion in the annual HBCC Directory please mail or bring this form to the October 3rd meeting.