🙏 HACLA Membership Application

Haitian American Christian Leadership Association

Annual Membership Fee: **[Insert Amount Here, e.g., $50]**

Section 1: Contact and Personal Information

1. Full Name (First and Last):

2. Date of Birth:

3. Professional Title / Occupation:

4. Organization / Church Affiliation (if applicable):

5. Email Address:

Phone Number:

Mailing Address:

6. Ethnicity / Background:

Are you of Haitian descent? Do you have a direct family connection to the Haitian community (spouse, parent, etc.)?

Section 2: Christian Leadership & Values

7. Statement of Faith/Values:

I affirm the mission and Judeo-Christian values of HACLA.

*Affirmation is required for membership eligibility.

8. Current Leadership Role (Select all that apply):

Pastor / Minister / Clergy Ministry Leader (Deacon, Elder, etc.) Community Leader (Non-Church related) Business Leader / Professional Student Leader None (I am a Supporter)

9. Briefly describe your experience in Christian leadership or community service (Max 150 words):

Section 3: Involvement and Interest

10. Why are you seeking membership in HACLA? (What are you hoping to gain?):

11. Which areas of HACLA's work are you most interested in? (Select all that apply):

Advocacy & Government Relations Civic Engagement / Voter Mobilization Professional Networking / Peer Support Leadership Development & Training Community Outreach / Local Events

12. How much time do you anticipate dedicating to HACLA events/activities per month?:

1-2 hours 3-5 hours More than 5 hours Supporter (Limited Time Commitment)

Section 4: Agreement and Submission

13. Membership Eligibility Agreement:

**I AGREE to the terms and conditions of HACLA membership.** (By checking, you confirm accuracy, agree to uphold values, and understand membership is subject to board review.)

14. Preferred Communication:

Email Text Message Social Media

15. Referral (Optional): How did you hear about HACLA? (If referred by a member, please state their name):