WEST QUODDY HEAD LIGHT KEEPERS’ ASSOCIATION
Membership Order Form
info@westquoddy.com 207-733-2180
West Quoddy Head Light Keepers’ Association,
P.O. Box #378, Lubec, ME 04652

 

*Billing Information*
Name:________________________
Billing Address:________________
_____________________________
State_____  Zip_____
 
Payment Method:
Check __ Credit Card__
Check Number____
Credit Card: Visa___   MasterCard___
Card Number_____________________
Card Expiration Month____ Year_____
Name on Card____________________

Tax deductible WQHLKA Memberships: Check your selection.

___Individual: $10.00 Annually, Membership Card and Newsletter

___Family: $15.00 Annually, Membership Card and Newsletter

___Business Level 1:  $25.00 Annually, Membership Card and Newsletter

___Business Level 2:  $50.00 Annually, Membership Card and Newsletter 
     plus your Business Listing on our site and business brochures at our Visitors Center

___Business Level 3:  $75.00 Annually, Membership Card and Newsletter plus your 
     Business Listing and your URL/email address linked on our site plus business 
     brochures at the Visitors' Center.

 

Total_________________