[OPPORTUNITIES] [MEMBERSHIP BENEFITS]

MEMBERSHIP APPLICATION

Please print out and mail this form to:
Friends of Seguin Island
72 Front Street, Suite 3
Bath, ME 04530
 

NAME(s):  _________________________________________________ TELEPHONE: (____)___________

ADDRESS:  ______________________________________________________________________________

CITY:  ___________________________  STATE: ____ ZIP: ________ EMAIL:_______________________

Enclosed is my/our contribution for a new membership in the Friends of Seguin Island, a nonprofit corporation organized for the purpose of maintaining, restoring, and preserving Seguin Island and its historical structures.

Please check your desired level of membership:

                              FIRST MATE (16 AND YOUNGER)           $10   ____

                              CAPTAIN                                                      $30   ____              

                              SEGUIN FAMILY                                         $55   ____              

                              ASSISTANT KEEPER                                 $100  ____               

                              LIGHTHOUSE KEEPER                             $250  ____

                              ADDITIONAL DONATION                        $________                  

My check is enclosed or my credit card payment choice is indicated below:

            VISA or MasterCard Credit Card # _____________________________________________

            Expiration Date: _______________  Signature_____________________________________

Please check here if  you would like to receive a Friends of Seguin Island decal: _______ 

THANK YOU VERY MUCH FOR YOUR SUPPORT!

The Friends of Seguin Island is a nonprofit 501(c)(3) IRS tax-exempt organization (Federal Identification Number 01-0420547).       No goods or services were provided in exchange for your membership contribution.