MOHC - 2024 Partnership and Membership

Partner/Member Information

• * Company:
• * Address 1:
• * Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * County:
• * Phone:

Personal Information

• * First Name:
• * Last Name:
• * Job Title/Position
• Prefix: --Choose-- Mr Mrs Miss Ms Dr Prof Rev Fr Sr Rabbi
• * Email Address:
• * Confirm Email Address:

• Fee

  Type	Fee
  Partner - Platinum	$20,000.00
  Partner - Visionary	$10,000.00
  Partner - Leader	$6,000.00
  Partner - Collaborator	$3,000.00
  Partner - Promoter	$1,500.00
  Partner - Supporter	$750.00
  Partner - Friend	$300.00
  Member - Individual	$75.00
  Member - Student	$25.00
  Member - Retired	$25.00

• Credit card transactions are done through PayPal, however you DO NOT need to have an account. Simply look for the option that says "Pay with Debit or Credit Card" or "Check Out as a Guest". You can then enter your card information without needing to careate a PayPal account.