Membership Form

Membership Category

Optional Donation

Total Amount

Email Address *

Membership page

Junior, Individual and Couples memberships apply only to members who are ordinarily resident in Bermuda.
The Membership year runs from October 1st to September 30th.

Don't forget to list an additional adult member (spouse or partner) and children under 18 in the fields below your personal information.

First Name *

Last Name *

I am contributing on behalf of an organization.

Yes No

Organization Name

Mailing address *

City (Leave blank for Bermuda addresses) *

Postal Code *

Country *

State/Parish

Phone

One additional ADULT member (spouse or partner)
for Family/Grandparent/Overseas Membership

Names of CHILDREN (under 18)
and their dates of birth (DD/MM/YY)
for Family Membership

I would like to know more about volunteer
opportunities

Yes No

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City

Leave city blank for Bermuda

Country *

State/Parish *

Postal Code *

Membership Form

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