(NOTE: this is only a pledge form - no financial transactions can occur on this site. All financial transactions, if applicable, are made offline after a registration request is submitted. ALL AND ANY INFORMATION SENT TO THE PROVIDENCE MARITIME HERITAGE FOUNDATION IS GUARANTEED TO BE KEPT IN THE STRICTEST CONFIDENCE).

* Please also note that this registration form works only with Netscape or Internet Explorer version 4.0 or higher - if you are not currently using either of these browsers and wish to become a member and/or make a donation, please contact
Kathleen McQuillan-Hofmann, Communications Director at kathleen_sloopprovidenceri@cox.net or call her at 401-274-7447

 
1. Personal Information
  Mr. Mrs. Ms.
 
First Name:
Middle Name:
Last
Street Address 1
Street Address 2
City
State & Zip Code
Phone Number
 
2. Membership Level (click HERE to see benefits)
  Individual ($35.00)
Student ($20.00 with valid student identification)
Family ($50.00)
Sponsor ($150.00)
Corporate ($500.00)
Corporate Patron ($1500.00)
Corporate Affiliate ($2500.00)
Corporate Sponsor ($5000.00)
Other Amount:
 
3. Preferred Contribution Method
  (note: this is a pledge form only - no transaction is possible below)
  Please PHONE ME for my credit card information.
  I will be mailing out a check or money order soon.*
   
 
   
  The Foundation is a non-profit 501-(C) (3) corporation. Your contributions are fully tax-deductible.

* Kindly make out your check or money order to:

Providence Maritime Heritage Foundation
408 Broadway
Providence, RI 02909

We thank you for you generous contribution. We look forward to hearing from you soon and seeing you on board!