JOINT MEMBERSHIP FORM EAST END LIGHTHOUSES, INC. AND AMERICAN LIGHTHOUSE FOUNDATION
Please Print this Form
DUES: $25.00 per Year
DATE:   _____________________
AMOUNT ENCLOSED:   __________________
DUES:   _____________    DONATION:   _______________   RENEWAL:   _______________
NAME:	___________________________________________________________
ADDRESS:	___________________________________________________________
CITY:	___________________________________________________________
STATE:	_______________         ZIP:   _____________________
E-MAIL:	___________________________________________________________
PHONE:	___________________________________________________________
Benefits include a Member Discounts, Newsletter and Information on Lighthouse Events of Interest.
Mail to: East End Lighthouses 2 Landing Meadow Rd. Smithtown, NY 11787-1108