Membership Application and Renewal Form CHECK ONE:* New Member Renewing Member First Name* Last Name* Street AddressCity State Phones, home/cell/workEmail Address* NORTHERN ADDRESS (for part-time FL residents):Street AddressCity 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 DonationEvery 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 NameThis field is for validation purposes and should be left unchanged.