2270 Kalakaua Avenue, Suite 1506, Honolulu, HI 96815 Tel: (808) 923-0407 Fax: (808) 924-3843 E-mail: [email protected] Date____________________ APPLICATION FOR “SPECIAL ACTIVE" MEMBERSHIP "SPECIAL ACTIVE" 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. Such special class of active members shall have the right to hold office in the Hawaii Lodging and Tourism Association and vote at all meetings of the membership, but shall not be entitled to 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. "SPECIAL ACTIVE" members shall pay the same dues as "Associate" members. Name of Company ______________________________________________________ Street Address (include zip) ______________________________________________ P.O. Box (include zip) ___________________________________________________ Name of Applicant______________________________ Title______________________ Telephone:___________________________ Fax:_____________________________ E-mail address ___________________________ Website ___________________________ Assistant’s Name & Title_______________________________ Phone ________________ Assistant’s E-mail ___________________________________ Properties Under Management: ___________________________________________ Signature of Applicant____________________________________________________ ANNUAL INVESTMENT: $175.00 annual dues, submit with originally signed application. Payment may be made by check (payable to: Hawaii 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