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Membership Form - Boatswain Tier
Amount
*
$100
-
Boatswain 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 to receive an LWSA hat as a thank-you gift ?
*
(some people want a hat and others prefer not)
Yes, I would like my LWSA hat
No, thank you
