Department of Health - Electronic Registration System

* Performer Type: Non Religious (Civil) License
Marriages or civil unions performed by solemnizers who are not properly licensed are not valid and cannot be registered. To ensure you are properly licensed, please check the correct box(es) below.

* I want to perform

Marriage

WARNING: If you are performing ANY marriage you MUST check this box.

Hawaii Revised Statutes, section 572-12 requires that a civil license performer be at least 18 years old.

Hawaii Revised Statutes, section 572-13.5 states that "Any license to solemnize marriages issued pursuant to section 572-12 may be revoked or suspended by the department of health, if the holder of the license has failed to comply with the applicable provisions of this chapter or of the rules of the department of health."

Civil Union

Civil union is NOT a marriage and performers who have this type of license only are not authorized to perform marriages.

Hawaii Revised Statuses , section 527-12 requires that a civil license performer be a least 18 years of age.

Act 1, section -4(e), Session Laws 2011, states that "The department of health may revoke or suspend a license to solemnize civil unions."
I attest, under penalty of perjury, that I meet the above requirements, that I have not had any previous licenses to perform marriages or civil unions revoked by the Department of Health and that no illegal substances or activities will be part of the ceremony.
I understand that the Department of Health may revoke or suspend my license if I fail to comply with the applicable provisions of Chapter 572 or the rules of the Department of Health.
I understand that the Department of Health may revoke or suspend my license to solemnize civil unions.
*Have you ever been licensed in the past to perform marriages in the State of Hawaii? Yes No

Yes, I am still with the same church affiliation.
Yes, I have changed my church affiliation since previously licensed.
If yes, please give previous license number
License Number:##-#### or A#######
*Have you performed any marriages in the State of Hawaii prior to this application? Yes No
If yes, please give approximate date and place (island) of last marriage
Date:MM/DD/YYYY
Place (Island):
Performer Title (e.g., Mr, Mrs, Dr):
* Performer First Name:
Middle Name:
* Performer Last Name:
* Date of Birth: MM/DD/YYYY
* Residence Address Line 1:
Residence Address Line 2: Apartment or suite (max. 5 characters)
* City:
* State:
Province:
* Zip/Postal Code:
* Country:
Mailing address same as residence address
* Mail Address Line 1:
Mail Address Line 2:
* City:
*State:
Province:
* Zip/Postal Code:
* Country:
At least one phone number is required
* Residence Phone: ###-###-#### or +##-##-####-####
* Cell phone: ###-###-#### or +##-##-####-####
* Business phone: ###-###-#### or +##-##-####-####
* Your E-mail: Will be used to send performer license and future renewal reminders.
* Confirm E-mail:

Application for License to Perform Marriages and/or Civil Union in Hawaii