Haiku Society of America

Online Information Form for HSA Membership

Use this page to provide membership information after you have paid membership dues. If you have not yet paid membership dues, please see our How to Join page. We must have this information to complete your online application for membership in the Haiku Society of America. When you are finished with the form, click the Send button to email a copy of this information to us.

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HSA Membership Form

Member's Name:

Street Address 1:

Street Address 2:

City:

State/Province:

Zip/Mail Code:

Country:

Email:

Calendar year for which the membership dues should apply:
(See Membership is for a Calendar Year.)

Are you a new member of the HSA?
Yes No

May we publish your name and address in the HSA membershp list that is sent to all members?
Yes No

May we publish your email address in the HSA membershp list that is sent to all members?
Yes No

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