Membership Application Form
Choose Membership Level:
Student(with valid ID)$20
Friend/Senior (Individual) $45
Supporter (family/household)$75
Contributor $150
Sponsor $250
Patron $500
Penobscot Bay Society Sloop $1000
Penobscot Bay Society Schooner $2500
Name
(required)
First Name
:
Last Name
:
Salutation (ex: Mr., Mrs., Mr. & Mrs., Ms., Dr., Capt., Rev., Judge, Honorable, Esq, etc.)
:
Additional Name
First Name
:
Last Name
:
Salutation (ex: Mr., Mrs., Mr. & Mrs., Ms., Dr., Capt., Rev., Judge, Honorable, Esq, etc.)
:
Primary Mailing Address
(required)
Street
:
Street
:
Town/City
:
State
:
Zip Code
:
Phone
Phone
:
Secondary Address
If you are out of the area for part of the year, we can mail stuff to you at your secondary address.
Send to secondary address starting date
:
Date to stop sending to secondary address
:
Street
:
Street
:
Town/City
:
State
:
Zip Code
:
This membership is a gift from:
First Name
:
Last Name
:
Salutation (ex: Mr., Mrs., Mr. & Mrs., Ms., Dr., Capt., Rev., Judge, Honorable, Esq, etc.)
:
Mailing Address
Street
:
Street
:
Town/City
:
State
:
Zip Code
:
Phone
Phone
:
Comments
Comments
:
