Membership Form & Directory Information

Please type your name(s) EXACTLY as you wish it to appear in our Membership Directory. Fill out the form in full and click submit. You will be prompted to select either a mail-in or Paypal option to pay the application fee. If you choose the mail-in option, please make your check payable to "Aqualane Shores Association, Inc.".

LAST NAME(S):		FIRST NAME(S):
STREET #:		LOCAL ADDRESS:
UNIT #:
CITY:		STATE:
ZIP:
LOCAL PHONE:		CELL PHONE:
OTHER PHONE:		EMAIL:
RESIDENCY:	FULL TIME PART TIME
I / WE ARE GENERALLY IN NAPLES FROM:
START MONTH:	JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER	END MONTH:	JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
ALT ADDRESS:		LIST EMAIL IN THE DIRECTORY?	YES NO
UNIT #:
CITY:		STATE:
ZIP:		COUNTRY:
PREFERRED MAILING ADDRESS:
	EMAIL-ONLY LOCAL ADDRESS ALTERNATE ADDRESS
*YOUR OTHER ADDRESS WILL NOT BE PRINTED IN THE DIRECTORY **WE ENCOURAGE YOU TO JOIN THE "EMAIL-ONLY" LIST TO HELP US MOVE TOWARD COST-EFFECTIVE ELECTRONIC COMMUNICATIONS. EMAIL ADDRESSES ARE USED ONLY FOR OFFICIAL AQUALANE SHORES BUSINESS AND CITY / COUNTY NOTIFICATIONS OF AN URGENT NATURE> PARTY INVITATIONS WILL BE MAILED VIA UPS POSTAL SERVICE.
NOTES:
ENTER THE CODE ABOVE: