Maine Chapter AMC
MEMBERSHIP-IN-A-BOTTLE APPLICATION


To join the Maine Chapter AMC for the first time or to order as a gift for another person, print this page and fill in the form.  Make your check payable to Appalachian Mountain Club and send it to Membership Mailing AddressPLEASE NOTE: Fields with an asterisk are required to process your application. This application should NOT be used for membership renewals, please use the standard application form for that purpose.


AMC Maine Chapter
Membership-In-A-Bottle

Ben Smith
105 New Gloucester Road
No. Yarmouth, ME 04097
207-829-8076
Please send AMC Membership-In-A-Bottle to:
*Name ___________________________________________
*Address _________________________________________
*City ____________________ *State _____ *Zip_________
Home Phone _____________________________________
Work Phone _____________________________________
E-Mail Address __________________________________
      If this Membership-In-A-Bottle is a GIFT, please enter your name and address below:
*Name ___________________________________________
*Address _________________________________________
*City ____________________ *State _____ *Zip_________
Home Phone _____________________________________
Work Phone _____________________________________

I have checked the membership options I want below:


$50.00 - Individual
$75.00 - Family (2 or more)



$ __________ ADD for Contribution to:

Maine Chapter
Appalachian Mountain Club

$ __________ TOTAL enclosed with my check (Sorry, no credit cards)


Membership application from Maine Chapter AMC web site
Last Updated: 2/22/04