Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.JOIN the Cape Cod Hospital Auxiliary-Orleans Branch Registering and renewing is easy! Below is the on-line membership form for 2024-2025 CCHA-ORLEANS. You will receive an email confirmation that you have submitted this form from CCHA-ORLEANS when you hit the SUBMIT button. Membership Type *New Member – $25.00Renewal – $25.00First Name *Last Name *Email *EmailConfirm EmailCheck this box if the email address above is NEW since your last membership renewalHave there been changes to your address or phone number since your last membership renewal? *NoYesCheck all that apply *Mailing AddressResidential AddressPhoneMailing Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeResidential Address (if different from mailing address above)Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *How did you hear about CCHA-Orleans?Current or Former MemberOnline SearchOrleans USPS Bulletin BoardNewspaper, Radio or TVPast Fundraising EventSocial Media (Facebook)OtherHow did you hear about CCHA-Orleans?OPPORTUNITIES TO GET INVOLVED IN OUR AUXILIARY AS A COMMITTEE CHAIR OR IN A SUPPORTING ROLECommittee Chair (you can choose more than 1)Dollars for ScholarsHistorianHolly Berry BazaarHospitalityMarketing CommunicationsMembershipNominatingProgramsPropertyPublicityPuppetsWays and MeansSupporting Role (you can choose more than 1)AdministrativeHolly Berry BazaarHydrangea FestivalMarketing CommunicationsPhotographerPuppetsRaffle Ticket SalesSocial Media/WebsiteSolicit Event SupportersWork at EventsOtherCan No Longer be ActiveCan no longer be actively involved but would like to continue membershipPlease consider an additional donation. All contributions go towards our current pledge. Not at this time$25$50$100Other amountDonation AmountDonationTotal$0.00Credit CardCardName on CardProcessed by SquareSubmit
