Member Level - Transaction
Please select
Individual Membership
Student Membership
Dual Membership
Family Membership
Rock Harbor Membership
Flagler's Folly Society Membership
Planter Membership
Windley Key Membership
Matecumbe Membership
Tea Table Membership
Indian Key Membership
Member Level - Constituent
Please select
Individual
Student
Dual
Family
Rock Harbor
Flagler's Folly Society
Planter
Windley Key
Matecumbe
Tea Table
Indian Key
*
= Required Field
Membership Information
Individual ($65)
Student ($25)
Dual ($100)
Family ($150)
Rock Harbor ($250)
Flagler’s Folly Society ($250)
Planter ($500)
Windley Key ($1,000)
Matecumbe ($2,500)
Tea Table ($5,000)
Indian Key ($10,000)
Is this a new membership or renewal?
*
Please select
New
Renewal
Would you like to automatically renew this membership annually?
*
Please select
No
Yes
Name(s) as should appear on membership card(s) and in annual recognition (for example, if dual membership, John and Jane Doe or John Doe and Jane Smith):
*
Referred by:
This is a gift membership.
Gift Information
Deliver membership to
*
Please select
Gift recipient
Gift giver
Send renewal notice to
*
Please select
Gift recipient
Gift giver
Name of gift recipient
*
Mailing address of gift recipient
*
Email address of gift recipient
Phone number of gift recipient
This gift is from
*
Gift message
Contact Information
Title
Please select
Mr.
Mrs.
Miss
Ms.
Dr.
First Name
*
Last Name
*
Address
*
City
*
State
*
Postal Code
*
Country
Email
*
Phone
*
Payment Information
Yes, I would like to add 2.5% to my membership to offset the credit card fees
Amount
*
Card Number
*
CVV2
*
Card Type
*
Visa
MasterCard
American Express
Discover
Expiration Month
*
Expiration Year
*
Additional Comments
Powered by
eTapestry.com
.