Registration Form

NWHE Registration Form

Name:

Husband's Name (if applicable)

Street Address

City

Zip Code

Home Phone

Cell Phone

Email

Child(ren)'s Name(s) and Birthday and Grade

Job Choice 1

Job Choice 2

Job Choice 3

I am a current member of NWHE.YesNo***

***I understand that if I am not a current member of NWHE, this registration form will put me on a waiting list. New members will be added after July 2, 2012 until the 125 family cap has been reached. I will be notified after that date of my membership status with NWHE via e-mail.I understand.

I have read and agree to the Policies of NWHE.Yes

If you have special needs, or comments, please use this space.