One moment please...
Boothbay Region Historical Society Membership Form
Membership Level
*
$150
-
Brig Member
$100
-
Schooner Member
$50
-
Sloop Member
$30
-
Pinky Member
$
I am a:
*
New Member
Renewing Member
Contact Information
Name
*
First Name
Last Name
Mailing Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
Verify Email
Phone
Is there is anything else you'd like us to know?
Add 3% to my total amount to help cover the payment processing fees
