
To join ALS, please print out this page and mail it back to us at: American Littoral Society, Northeast Chapter, 28 West 9th Road, Broad Channel, NY 11693, or email us.for more information.
Special Instructions:
Gift Memberships: Check New or Renewal and Gift Membership
Clubs: Enter name of club under “organization”, primary contact person under “name”
Libraries:Enter name of institute under “organization”, primary contact person under “name”
Fish Taggers: Check new, renewal, or gift membership and the fish tagging box; indicate number of tag kits desired.
| Membership Status | |||
| ____ New | ____ Renewing | ____ Gift Membership | ____ I wish to participate in the fish tagging program |
| Membership Category | |||
| ____ $40 - Library | ____ $55 - Foreign | ||
| ____ $50 - Club | ____ $30 - Senior/Student | ||
| ____ $40 - Individual/Family | ____ $50 - Sustaining | ||
| ____ $100 - Supporting | ____ $250 - Advocate | ||
| ____ $500 -Littoral Leader | ____ $___________ or more |
| Member Information | Gift Recipient Information | |
| Name_______________________________________ | Name_______________________________________ | |
| Organization_________________________________ | Organization_________________________________ | |
| Address_____________________________________ | Address_____________________________________ | |
| City ____________________ State ____ Zip_______ | City ____________________ State ____ Zip_______ | |
| Phone______________________________________ | Phone______________________________________ | |
| E-mail ______________________________________ | E-mail ______________________________________ | |
| Brief Message: _______________________________ ____________________________________________ ____________________________________________ |
| Fish Tagging Kits Needed (Price includes shipping & handling) | Payment Enclosed | |
| Tag kit with needle - $6 each Qty:__________ | Membership Dues $ _______________ | |
| (includes needle for tagging fish, 10 tags, instructions) | Fish Tagging Kits $ _______________ | |
| Tags only kit - $5 each Qty:__________ | Total Enclosed $ _______________ | |
| (includes 10 tags, instructions) |