Membership Form

PORT OF NEW YORK BRANCH - WORLD SHIP SOCIETY

P.O. Box 384, New York, NY 10185-0384

~ PLEASE PRINT AND MAIL ~

Name_______________________________________________________________

Address_____________________________________________________________

City_______________________________ State_____________ Zip_____________

Home Phone ( ___ )______________Business Phone ( ___ )__________________

Email________________________________________________________________

Type of Annual Membership: SINGLE FAMILY*

Regular $35 $45

Sustaining $55 $55

Patron $75 $75

British membership.........Write or e-mail us for cost of British membership dues.
*Family membership in any category includes one additional person in the same household.
Name of additional Family Member (if applicable)______________________________
Total Amount Enclosed:___________________
Area(s) of Specific Maritime Interest_________________________________________

WORLDSHIPNY.COM 2/04

Type of Annual Membership:	SINGLE	FAMILY*
Regular	$35	$45
Sustaining	$55	$55
Patron	$75	$75