Membership Application – Hearts of Miromar

NOTE: Any line with an asterisk (*) is required to be complete for the form to be submitted.

Price: *

Price: $50.00

Your Name*

Preferred FIRST name for Name Tag

New or Renewing Member*

I am a NEW MEMBER to Hearts of Miromar
I am a renewing member & NONE of my information has changed from last year
I am a renewing member AND have CHANGED SOME of my information

E-Mail Address*

Cell Phone*

Miromar Phone

Alternate Phone

Miromar Address*

Alternate Address

Your Birthday (Month - Day & Year)*

Miromar Neighborhood*

Please select the following that are applicable:*

I own in Miromar
I rent in Miromar
I am ONLY a Member of Miromar Golf Club
I reside in Miromar Full Time
I am a Seasonal Resident

----Spouse/Partner Information----

Spouse
Partner

Spouse/Partner's First & Last Name

Spouse/Partner's Birthday (Month - Day & Year)

Anniversary (Month - Day & Year)

HOM Luncheon Choices - There will be (3) menu selections for each Luncheon. One will be vegetarian. ONLY MEDICAL FOOD ALLERGIES will be accommodated by the kitchen. It is YOUR responsibility to confirm your MEDICAL FOOD ALLERGIES with the wait staff prior to being served. MEDICAL FOOD ALLERGIES I have are as follows:*

I do want my alternate address in the HOM Directory along with my Miromar address

Yes
No

Thank you for your support of Hearts of Miromar! Any additional notes may be added here:

Your dues open the doors to many club activities, attendance at our monthly luncheons & voting privileges on important matters, such as bylaw amendments and election. CLUB SIGN-UPS are done by YOU! Please email the Chair/co-Chair of each club you are interested in and provide them with your contact information letting them know you are interested in joining their club. Contact names can be found in the Weekly Updates. WELCOME TO HEARTS OF MIROMAR where women treat each other with dignity, respect, kindness and inclusion while fostering and strengthening friendships, promoting community goodwill and supporting local charities. To that end, all members can expect to be treated and to treat others in a civil manner.

October 1, 2023 to September 30, 2024