Chesapeake Chapter, US Lighthouse Society

	APPLICATION

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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 1^st class mail. Inspectors and Superintendents will receive an appropriate gift.

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New Application

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If another site... which one?

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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,
	E-Mail:

You will receive your first newsletter within two weeks after we have processed your membership form.