Help build the CHOPTANK RIVER LIGHTHOUSE & become a
Keeper of the Light

 
If you would like a printable, mail-in application, please click here.
If you would like to pay via credit card, please fill out the application below.

Commodore/Benefactor $25,000.00
Name is permanently placed on a step riser

 

Vice Commodore $10,000.00
Name is placed on a plaque around the lens

 
Captain $5,000.00
Name is placed inside a lighthouse display 		 
Head Keeper $2,500.00  
Assistant Keeper $1,000.00  
First Mate $500.00
All of the above contributors listed on a permanent plaque in lighthouse 		 

Wicky $100.00 (full family membership)
Receives one lighthouse book

 
Swabby $35.00 (individual membership)
Receives CRL pin 		 
Senior Keeper $16.00 (under 16)  
Junior Keeper $5.00 (under 10)  
Keeper's Mascot $2.50 (pets only)  
     
Name:  
Address:  
   
City:  
State:  
Zip:  
email:  
 
Member Level:

 
Card Type:

 
Name (as it appears on Credit Card)  
Credit Card Number:  

Please enter the expiration date as follows: two digits of month and two digits of year.
For instance, January 2004 has to be entered as 0104:

 
Exp. date (mmyy):  
The Card Verification Code (Card ID or CVV2) is required for American Express, Visa and MasterCard.
For American Express - 4 digits on front of card; For Visa and Mastercard - last 3 digits on back of card: 		 
Card ID Number:  
Please enter the address at which the credit card bills are received:  
Street Address:  
City:  
State:  
Zip:  
Country:  
     
Contact me for volunteering to help build the lighthouse.  
   
     
 
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