NAME(s):  __________________________________________TELEPHONE: (______)_____________

ADDRESS:  __________________________________________________________________________

CITY:  ________________________ STATE: ____  ZIP: __________ EMAIL:____________________

Enclosed is my check or I have indicated my credit card payment choice as follows:

            VISA or MasterCard Credit Card Number: ______________________________________

            Expiration Date: ____________  Signature:______________________________________

Please mail order form to this address:

Friends of Seguin Island
72 Front Street, Suite 3
Bath, ME 04530

Thank you very much for your support.