membership form

(NOTE: We do not sell or publish your member information for any reason. We will not call your mobile phone or send a text unless there is an island specific need. For more information please call 978-463-0670)

Membership Application

First Name


Last Name


Email Address


Cell Phone


Other Phone

Mailing Address

Street


City


State
- Please Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Plum Island Address

Same as mailing address

Street


City


State
- Please Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Membership Type
- Please Select -Individual ($35/year)Family ($50/year)

New / Renewal
New MembershipRenewal

Volunteer
Would you like to be contacted for PITA volunteer projects?
- Please Select -NoYes

If you like, tell us your special skills or interest for volunteering:

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