Project Liberty Ship - Membership Application

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Please print this page, fill it out and mail it to: PROJECT LIBERTY SHIP PO Box 25846 Highlandtown Station Baltimore, MD 21224-0546 USA

Name :________________________________________________________________ Street:______________________________________________ Apt # :__________ City :______________________________________________ State :__________ ZIP/Postal Code:_____________________ Country :________________________ E-mail address :_______________________________________________________ Phone (daytime):______________________ (evening):______________________

Please Circle Type of Membership Desired:

$30
Annual Member

$40
Annual Foreign Member

$50
Annual Family Member- ship

$100
Annual Honorary Ships Officer

$250
Annual Honorary Captain

$250
Annual Honorary Chief Engineer

$250
Annual Honorary Armed Guard C.O.

$500
Lifetime Honorary Convoy Commander

$1000
Lifetime Honorary Admiral

$1000
Annual Corporate Sponsor

I'd like to volunteer in the: Engine Room____ Deck____ Ship's Store____ Office____ Library____

Do you hold a current merchant marine license or documentation (yes/no)?______

If yes, what license or documentation?________________________________________

Method of Payment:

Cash or Check	Credit Card (circle one) -->	Visa	Master Card
Please make checks payable to PROJECT LIBERTY SHIP	Credit Card Number
	Name on Credit Card
	Expiration Date
	"V" no. (last 3 digits on back of card near signature box)

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DO NOT transmit your credit card information via this website or email.