MEMBERSHIP APPLICATION

MEMBERSHIP                                              ANNUAL                         LIFETIME

______SINGLE                                         ______$25                        _______$150

______FAMILY                                          ______$35                        _______$200

______BUSINESS                                    ______$50                        _______$300

______PATRON                                                                                 _______$500

______BENEFACTOR                                                                        _______$1000


Name(s) _________________________________________________________

_________________________________________________________________

Address _________________________________________________________

_________________________________________________________________

Town ____________________________________________________________

State _______________________________  Zip __________________________

Telephone # _______________________________________________________

E-Mail ____________________________________________________________




Please make checks payable to:

Friends of BLSP

Mail to:

Friends of BLSP
P.O. Box 923
Barnegat Light, NJ 08006


Electronic payment options coming soon!
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