Membership Application and Renewal Form

CHECK ONE:*
- New Member
- Renewing Member
First Name*
Last Name*
Street Address
City
State
Phones, home/cell/work
Email Address*
NORTHERN ADDRESS (for part-time FL residents):
Street Address
City
State
Zip
Date going north:
MM slash DD slash YYYY
Date returning south:
MM slash DD slash YYYY
MEMBERSHIP TYPE (PLEASE SELECT ONE. DONATION IS OPTIONAL.):*
NOTE: dues increased by $10; if you do 5 hours of JGSGO work, you avoid the extra $10
- Lifetime - You are a permanent member who really helps pay our bills - $250.00
- Individual - General membership for one person. - $35.00
- Family - General membership for those living at the same address. - $40.00
- Associate - General membership for those residing out-‐of-‐town beyond a 50 mile radius. - $30.00
Donation
Every donation, no matter the size, helps us to meet our goals. All donations are tax deductible as we are a 501(c) (3) organization.
Total Enclosed
$0.00
Phone
This field is for validation purposes and should be left unchanged.