Name:
Addr1:
Addr2:
City: State:
County: Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Fax:
Email:
Website:
Member Fee:
Cash: Check #:
Date:
New Members Signature:
____________________________________
Received By:
____________________________________
Addr1:
Addr2:
City: State:
County: Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Fax:
Email:
Website:
Member Fee:
Cash: Check #:
Date:
New Members Signature:
____________________________________
Received By:
____________________________________
Members of the Royal Order of Don Juan Ponce
de Leon Historical V Centennial Celebration
Committee include individuals, businesses,
corporations, and international persons or
entities.
As a member you enjoy participation in
Historical Committee events and programs
while supporting its vital mission.
Student Membership
Individual Membership
Family Membership
Small Business Membership
Non-Profit Membership
Corporate Membership
Benefactor Membership
Life Membership
Individual Membership
Family Membership
Small Business Membership
Non-Profit Membership
Corporate Membership
Benefactor Membership
Life Membership
$15.00
$50.00
$60.00
$75.00
$100.00
$150.00
$500.00
$1000.00
$50.00
$60.00
$75.00
$100.00
$150.00
$500.00
$1000.00
International Memberships are available
for an additional $10.00.
International Membership
payable to:
Royal Order of Don Juan Ponce de Leon Historical Committee
Mail completed application
and money to:
U.T.B. United Third Bridge, Inc.
Royal Order of Don Juan Ponce de Leon Historical V Centennial Committee
2293 Aurora Rd
Melbourne, FL 32936-0505
For questions regarding membership please call (321) 863-5165, or send us your question at "UTBLOPEZ@aol.com".