HWPA Membership Application
Complete the form below to apply for membership with the Hawaii Waiver Providers Association.  

Each member organization must supply information on a primary point of contact.  Additional individuals within your organization that would like to subscribe to the HWPA mailing list may be added at the bottom of this form at no extra cost.

Upon completion, an invoice will be sent to the primary contact for your respective dues amount.  Due amounts are dependent upon annual waiver revenue and indicated below.

Please contact hwpa@hawaiiwaiverproviders.org with any questions about membership.
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Name of Organization *
Organization Website
Primary Point of Contact Full Name (this person will receive annual invoice) *
Primary Point of Contact - Phone Number
Primary Point of Contact - Email Address *
Primary Point of Contact - Mailing Address *
Type of Membership *
Organization Waiver Revenue (this determines dues amount) *
List services organization provides
Area served by organization *
Additional Subscribers - Full Names & Emails
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