Please
print this form and fill in the information
Membership fee: $10.00 per year
Jan through Dec
or
$50.00 Life Membership |
| First Name |
______________________________ |
| Last Name |
______________________________ |
| Street Address |
______________________________ |
| City |
______________________________ |
| State/Province |
______________________________ |
| Zip/Postal Code |
______________________________ |
| Husband's Name |
______________________________ |
| Ship Name |
______________________________ |
| Ship Number |
______________________________ |
| Home Phone |
______________________________ |
| Work Phone |
______________________________ |
| Email Address |
______________________________ |
| Webpage URL |
______________________________ |
