Become A Member of HAPC

HAPC Membership Online Membership Application

Thank you for choosing to become a member of HAPC. We take pride in providing an opportunity for the Haitian Communities in the U.S. and Haiti to grow personally and professionally.

In order for application to be complete and considered, we will need the form filled out in its entirety.
If you have any questions, please do not hesitate to reach out to us via email at info@hapcoalition.org. Thank you!
Organization information
Name of Organization*
Type of Organization*
Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Organization Phone*
Organization Email*
Organization Website*
Board Members of the Organization
President / Chairperson Name*
First Last
President / Chairperson Phone*
President / Chairperson Email*
Vice President / Vice Chairperson Name*
First Last
Vice President / Vice Chairperson Phone*
Vice President / Vice Chairperson Email*
Treasurer Name*
First Last
Treasurer Phone*
Treasurer Email*
Secretary Name*
First Last
Secretary Phone*
Secretary Email*
Contact Person Information
Contact Name*
First Last
Contact Phone*
Contact Email*
Detailed Information about the Organization
Organization Vision*
Mission Statement*
Organization Description*
Organization Accomplishments
Registration Renewal Details
Type of Registration*
- Regular Members ($250)
- Affiliate Members ($125)
- Associate Members ($75)
- Honorary Members
- Advisory Board Members
- Student ($25.00 Donation)
Please Select Committee*
For organizations that join us in 2019, we are waiving their first year dues. However, for 2020, invoice for dues will be sent out in October 2019, as the month of October is when we renew membership.
Consent & Release
Do You Agree To The Consent & Release?*
Yes, I Agree
I herby irrevocably grant to the Haitian American Professionals Coalition, Inc. (HAPC) my full consent to use my name and the organization I represent with any pictures, photographs or likeness of me in any work/volunteer activities (including, without limitation, brochures, newsletter, articles or any other publications in any and all media including advertising, publicity and administration materials), and to exercise all of the rights granted hereunder without my further prior approval.

I hereby agree that I shall have no right (including, without limitation copyright) title or interest in works created by HAPC pursuant to this agreement. I hereby agree that I shall have no claim of any kind (including, without limitation, claims deriving from the right of publicity, right of privacy or libel) against HAPC or its successors, related entities, licensees or assignees, based on the exercise of any rights granted hereunder.
Signature*
Print Name For Digital Signature
(*) Required fields
Upon clicking the "Activate Membership" button, you will be taken to our paypal payment page (You do not need a paypal account to pay). Please be patient until the page loads. Once payment is made you will return to this website and you will receive an email from us about your new active membership status.

Become A Member of HAPC

HAPC Membership Online Membership Application

Organization information

Board Members of the Organization

Contact Person Information

Detailed Information about the Organization

Registration Renewal Details

Consent & Release

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