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. First Name *Last Name *Mailing 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 *Email *EmailConfirm EmailMembership Type *New Member – $25.00Renewal – $25.00How did you hear about CCHA-Orleans?Current or Former MemberOnline SearchOrleans USPS Bulletin BoardPast 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)HistorianHolly Berry BazaarHospitalityMembershipNominatingProgramsPublicityPuppetsWays 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 Card *CardName on CardProcessed by SquareSubmit
