Membership Application

POINTE AUX BARQUES LIGHTHOUSE SOCIETY

First Name:

Last Name:

Spouse First Name:

Spouse Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Country:

E-mail:

Publish Email?

 (If no, email address will not be disclosed on password protected website member list)
Please indicate your permission to place your personal information on the Members Only section of our website. It is password protected:
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Home Phone:

Business Phone:

Membership Date:

Fax:

Date Dues Paid:

Membership Type:

Username:

Password:
Membership Status:
 New Member Renewal  
Family membership (two adults) entitles the family to (1) business vote at meetings.

Please complete and print this application and mail it with your check for $25

payable to the Pointe Aux Barques Lighthouse Society (PABLS) to:

Sandy Affholter , Acting Secretary

8114 Rubicon Rd.
     
Port Hope, Michigan 48468