Membership Input Form — Little Balboa Island

Name

First Name

Last Name

Membership level

Admiral ($1,000)

Commodore ($500)

Captain ($250)

Lieutenant ($125)

Ensign ($65)

Associate membership ($65 for non property owners)

Little Island address

Email address

Mailing address

Telephone

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Cell phone

(###)

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Spouse's name

Spouse's telephone

(###)

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Second or spouse's email address

What year did your family acquire this property?

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