Membership Registration Form

District of Columbia Hampton Parents' Club Inc.
P.O. Box 70062 Washington, DC 20024-0062

Membership Type:
New Parent Member	Dues = $35.00
Continuing Parent Member	Dues = $35.00
Associate Member	Dues = $25.00
Friend	Dues = $20.00

	Name Tag (optional) - $ 7.50

Name:
(Parent, Guardian, Friend)
Address:

Profession: (mother)
Profession: (father)

Telephone Numbers: (H)
(W) father (W) mother
Email address:

Include My Contact Information in the DCHPC Membership Network Listing.
DO NOT Include My Contact Information in the DCHPC Membership Network Listing.

Student Name:
Classification:
Area of Study:

Please check the committee or activity on which you would like to work:
Alumni Liaison	Membership
Chartered Bus	Newsletter
Freshman Reception	Parents' Weekend
Fundraising	Scholarship
University Relations	Website

Application Date:

Please make checks payable to :
D.C. Hampton Parents' Club, Inc.
mail payment along with this form to address above.