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)