Membership Information You have selected the Silver Sustaining membership level. Membership Level: Silver SustainingPayment Method: Auto Renewal The price for membership is $300.00 per Year. Do you have a discount code? Click here to enter your discount code Discount Code Family Information First Name / Names e.g. Fred and Wilma Last Name / Names e.g. Flintstone Full Mailing Name e.g. Mr. and Mrs. Frederick Flintstone Children Separate names with commas. No quotation marks or carriage returns. Member 1 Information First Name – Member 1 Last Name – Member 1 Username Auto-generated, not editable. This username can be used for login. Password Show Password Confirm Password Email Address This email address can also be used for login. Confirm Email Address Full Name LEAVE THIS BLANK Phone – Member 1 Format: 999-999-9999 Phone Type – Member 1 Mobile Landline Communication Preferences – Member 1 Receive Email Communications (2–4 emails per month in the summer) Receive Monthly E-Newsletter Receive Text Communications (consent to SMS from LBCA) Already have an account? Log in here Member 2 Information First Name – Member 2 Last Name – Member 2 Email – Member 2 This email address MAY NOT be used for login. Phone – Member 2 Format: 999-999-9999 Phone Type – Member 2 Mobile Landline Communication Preferences – Member 2 Receive Email Communications (2–4 emails per month in the summer) Receive Monthly E-Newsletter Receive Text Communications (consent to SMS from LBCA) Lake Information Lake Address Lake City Lake State Lake Zip Lake Landline Phone Cove / Area Lot Number House Name Home / Mailing Information Mailing Address Mailing Address Line 2 Mailing City Mailing State Mailing Zip Home Landline Phone Additional Information Primary Contact for LBCA Member 1 Member 2 Account Email Address Used for billing + account notices. Often same as Member 1 email. LBCA Join Date Original join date. If this date is incorrect, please feel free to update it to capture at least the year you joined. Directory Information Include my Information in the Printed Directory? Yes No How many Printed Directories would you like to receive? Select from 0-2. Directory And Profile Preferences Show location on map Street Name City State Zip Code Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands US Armed Forces Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Group Account Information This purchase includes 10 additional seats. Group members will be able to claim the Additional Member membership level. Payment Information Card Number Expiration Date CVC Discount Code LBCA uses a PCI compliant payment processor and cannot see or store member credit card information. Processing…
