Application for New Membership in the
New Dungeness Lighthouse. 

Email Completed Application to:  Scheduling@NewDungenessLighthouse.com

Date Paypal payment was made: 
Name on Paypal in different:


First Name= 
Last Name= 

Spouse First Name= 
Spouse Last Name= 

Mailing Address= 
Apt#= 
City= 
State= 
Zipcode= 
Country=USA 

Primary Phone= 
Alternate Phone= 
Fax= 
Work Number= 

Email Address= 

Send the Newsletter via Email or Paper Mail: 
 
Child1 Name= 
Child1 Birth Year= 

Child2 Name= 
Child2 Birth Year= 

Child3 Name= 
Child3 Birth Year= 

Child4 Name= 
Child4 Birth Year= 

If giving the membership is a gift to someone, 
let us know who they are:

Donor First Name= 
Donor Last Name= 

Donor Phone= 
Donor Mailing Address= 
Donor Apt#= 
Donor City= 
Donor State= 
Donor Zip= 
Donor Country= USA 

Thank You for Joining the New Dungeness Lighthouse Association!