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Membership
Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Dates off Cape
Off Cape Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
*
Verify Email
*
Home Phone
Cell Phone
Membership amount
*
$75
-
Individual
$100
-
Family
$250
-
Seeker
$500
-
Sponsor
$1,000
-
Explorer
$
Additional Scholarship Fund Contribution
$
Add 3% to my total amount to help cover the payment processing fees
