Primary Account Information

* First Name:
* Last Name:
* Address:
* City:
* State:
Province (Foreign)
* Zip Code: -
* Email:
* Contact Phone:
Contact Phone 2:

Secondary Address

If you have a seasonal or secondary address, please provide that information here.

Secondary Address:
Province (Foreign):
Zip Code: -
Secondary Address Months

Requested Membership Level

* Membership: $35 - Individual
$50 - Household
$100 - Patron
$250 - Benefactor
$500 - Conservator
$750 - Trustee of the Land
$1,000 - Keeper of the Land
$2,500 - Guardian of the Land
$5,000 - Steward of the Land
Click this box to have the membership you have selected automatically renew.

Lemon Bay Conservancy, Inc., is a 501 (c) 3 non-profit corporation with its principal place of business in Florida.  Contributions to the Conservancy may be tax deductible to the extent provided by law.  A COPY OF THE OFFICIAL REGISTRATION (CH14541) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE, WITHIN THE STATE, 1-800-HELPFLA, OR VIA THE INTERNET AT WWW.800HELPFLA.COM  REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL,  OR RECOMMENDATION BY THE STATE.

Additional Donation with Membership:
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