Passport Form

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

Instructions for submission:

1. 1. 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 hit the submit button without printing first you will lose all the information entered.
      3. SUBMIT. Click the submit button, your form will be sent electronically to our Secretary. 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 * First Last E-mail * Address * Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Passport Stamp: Baltimore Harbor Bloody Point Bar Cape Charles Chesapeake Light Tower Craighill Channel Lower Front Range Craighill Channel Lower Rear Range Craighill Channel Upper Front Range Craighill Channel Upper Rear Range Fishing Battery Fort Carroll Jones Point New Point Comfort Newport News Middle Ground Old Point Comfort Point No Point Pooles Island Sandy Point Shoal Sharps Island Smith Point Solomons Lump Thimble Shoal Thomas Point Wolf Trap Message Word Verification: type_submit_reset_13 SubmitReset

BEFORE CLICKING SUBMIT… PRINT THIS FORM

after you have filled in the information. Click Submit to send your order. 

You can also print this form blank and give it to a friend who may not have internet access.