2270 Kalakaua Avenue, Suite 1506, Honolulu, HI 96815 Tel: (808) 923-0407 Fax: (808) 924-3843 E-mail: [email protected] Date____________________ APPLICATION FOR "SOLE PRACTIONER" MEMBERSHIP "SOLE PRACTIONER” members shall be persons active in the management of a group or chain of lodging properties wholly or partly engaged in business in the State of Hawai`i or is active in the lodging business outside the State of Hawai`i. Sole Practitioner members shall have the right to hold office and vote under the circumstances set forth in Section I of Article XI hereof. If accepted, the undersigned agrees to pay membership dues and abide with the rules governing membership, as provided by the Association bylaws. "SOLE PRACTIONER” members shall pay the same dues as "Associate & Special Active" members. Name of Company __________________________________________________________ Name of Applicant________________________________ Title______________________ Street Address (include City, State, Zip) _________________________________________ P.O. Box (include City, State, Zip) ______________________________________________ Phone:____________________ Cell Phone: _________________ Fax:_________________ E-mail address ___________________________ Website ___________________________ Assistant’s Name & Title______________________________________________________ Assistant’s Phone: ___________ Assistant’s E-mail _______________________________ Properties Under Management: ________________________________________________ Signature of Applicant________________________________________________________ ANNUAL INVESTMENT: $175.00.00 annual dues, submit with originally signed application. Payment may be made by check (payable to: Hawai`i Lodging and Tourism Association) or by major credit cards. For credit card payment, please complete the information below: Type of credit card (circle one): American Express Visa MasterCard Discover Account No:_____________________________ Card Code: ______ Expiration Date: _________________ Name on Credit Card: _________________________ Cardholder’s Signature: _______________________ CREDIT CARD BILLING ADDRESS: __________________________ CITY, ST, ZIP: ___________________ ----------------------------------------------------------------------------------------------------------------------------INTERNAL ACTION ONLY Board of Directors Action_________________ Date____________ Membership # _______________ 5/29/15