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Membership Form

Chesapeake Chapter of the U.S. Lighthouse Society – Membership Form

Instructions for submission:

  1. FILL OUT FORM. Fill in all required fields in form below.  Or complete only step 2 to print a blank form to give a friend.
  2. PRINT. Click the print button on the upper right corner of the page, make 2 copies, one to send with your payment and one for your records.
    NOTE: If you click the submit button without printing first you will lose all the information entered.
  3. SUBMIT. Click the continue button, your form will be sent electronically to our Membership Chair. You will be sent to the payment page.
  4. PAY. On the payment page you can pay via PayPal or follow the directions for mailing your check made payable to: Chesapeake Chapter

Name *
E-mail *
Address *
Phone: *
This membership is a: *
Type of membership: *
Name of Mascot (if applying for pet mascot membership)
Mascot breed (if applying for pet mascot membership)
Payment via: *
Do you wish to be included in the Chapter email news group? *
If new application, how did you hear about us? We also welcome your comments:
Word Verification:

BEFORE CLICKING CONTINUE… PRINT THIS FORM after you have filled in the information. Click Continue to Pay Online via PayPal or follow directions to mail us your payment.
You can also print this form blank and give it to a friend who may not have internet access.

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Membership Payment

Thank you for joining the Chesapeake Chapter of the U.S. Lighthouse Society We have received your request for membership and you should be receiving a confirmation, via e-mail, soon. If you haven’t already done so… Please send your check, made payable to Chesapeake Chapter, to this address: Membership Chairman Chesapeake Chapter, USLHS P.O. Box 1270 Annandale …