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Chesapeake Chapter - US  Lighthouse Association - Membership Application

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E-Mail Address:
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Membership Type: Choose
Keeper's Mascot (Member Pets Only) $2.50 One Time Fee
Family $20.00 Annually   *Keeper $50.00 Annually
Individual $15.00 Annually *Inspector $100.00 Annually
Student $10.00 Annually *Superintendent $250.00 Annually
Senior (55+) $10.00 Annually *Lifetime $750.00 One Time Fee
*These categories will each receive their newsletter via 1st class mail. Inspectors and Superintendents will receive an appropriate gift.

Membership Status:
New Application    Renewal   Change Of Existing
If New, How did you hear about us?
If another site... which one?

Final Comments:

Before you continue... PRINT THIS FORM after you have filled in the information. Hit Continue to Pay Online via PayPal or Credit Card.
You can also print this form blank and give it to a friend who may not have internet access.


The information you submit will never be used for anything other than chapter information.
We will never give out your information to outside parties.

Please enclose your check payable to "Chesapeake Chapter, USLHS"

and mail it to:

Membership Chairman
Chesapeake Chapter, USLHS
P.O. Box 1270
Annandale, VA 22003-1270,
You will receive your first newsletter within two weeks after we have processed your membership form.