LIGHTHOUSE CAMERA CLUB MEMBERSHIP APPLICATION
Name____________________________________________________________________ Address_____________________________________________________________________
City: _____________________________ State: _____________ Zip: ________________
Phone: _______________ E-Mail: __________________________
Occupation: __________________________
Areas of interest and experience in photography: _____________________________
______________________________________________________________________________
How did you learn about our Club?____________________________________________
Are you a full time Florida resident? Yes: ________ No: __________
If not, what is your secondary address? ______________________________________
City: _____________________________ State: _____________ Zip: ________________
Phone: _______________ E-Mail: __________________________
Current or past member of a camera club? Club Name______________________
City: ___________________________ State: ____________
I (We) agree to abide by the Rules and Bylaws of the Lighthouse Camera Club.
I (We) agree to serve on club committees as requested. I (We) agree to indemnify and hold harmless the Lighthouse Camera Club from liability resulting from my (our) participation in any club activities.
(Each applicant must sign)
Signed: ______________________________________ Date: ______________
Signed: ______________________________________ Date: ______________
Annual membership fee: $40.00
