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Membership Form - Navigator level
Amount
*
$500
-
Navigator Membership
Donation Schedule
One Time
Yearly
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Address Type
*
Home
Seasonal Summer
Seasonal Winter
Work
Mobile Phone
(optional)
Membership Card ?
*
Yes, I would like a membership card
No, I do not need a membership card
Membership Card name
*
Would you like your thank-you gifts of an LWSA hat, tote bag and shirt ?
*
Yes, I would like my thank-you gifts
No, thank you
Shirt Selection
Tick a type and a size
Men's Polo
Men's T-Shirt
Women's Polo
Women's T-Shirt
Size XL
Size L
Size M
Size S
