Membership Application Form

Type of membership you are purchasing:
SEAC Membership Application
*First Name:
*Last Name:
*Address:
Address 2:
Address 3:
*City:
*State:
*Zip/Postal Code:
*Contact Phone/Ext:	- - Ext.
Fax:	- -
*Email:

$37.50 Annual Standard Membership
$16.50 Annual Student Membership*
$42.50 Annual Family Membership
$78.50 Annual Institutional Membership
$500.00 Life Membership please submit paper membership form with check for payment to SEAC Treasure

Additional Information:
	This is a new membership.
	Please list my information in the Newsletter membership directory.

If you would prefer to mail your membership payment please click here to download and print a PDF version of the membership application and send it to: Karen Y. Smith 22 Forest Drive Palmyra, VA 22963 ksmith@monticello.org

*Student Memberships must submit a copy of their current student ID via email to ksmith@monticello.org

SEAC Membership Application