Online Membership Form

Welcome to the Cape Canaveral Lighthouse Foundation. Please enter your contact information below. For renewing members, this form helps us keep our records current.

New MemberRenewing Member
First Name: (required)

Last Name: (required)

Address - line 1: (required)

Address- line 2:

City: (required)

State: (required)

Zip Code: (required)

eMail Address: (required)

Phone Number: (required)

Cell Phone Number:

I have read and accept the Terms and Conditions of the
Cape Canaveral Lighthouse Foundation.

Pressing 'Send' will pass the information included in the form to the Foundation membership chairperson. The next page will help you pay the membership dues through PayPal.

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