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Panama Canal Society, Inc.
19001 Sunlake Blvd.
Lutz, FL 33558

On-Line Governors Club Application


The Governors Club – In response to member feedback and suggestions the Board has decided to create a new level of Society membership with special benefits and recognition—The Governors Club.  Each year many members forget to renew or allow their membership to lapse following a milestone reunion such as their 10 year or 20 year reunion.  The Governors Club is being created to recognize those members making a continued and long term commitment to the Panama Canal Society.  We are deeply appreciative of our members that have renewed every year and we are looking at ways to recognize those members with multiple years of membership.

The Governors Club is a 5-year membership in the Panama Canal Society.  Each new member in the Club will receive special recognition in the Canal Record and at the Panama Canal Society Reunion.  Upon joining members will receive a special gift package from the Society and additional benefits when attending the Panama Canal Society Reunion.  Membership is now due, so why not make it a special membership and join the Governors Club!

 

Member Information
Full Name:*
A value is required.
Nick Name (if desired)
Maiden Name (if applies)
Spouse Full Name:
Spouse Nick Name
(if desired)
Spouse Maiden Name
(if applies)
Mailing Address:*
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Address Cont:
City:*
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State/Province:*
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Zip/ Postal:*
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Country:*
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Home Phone Number:*
unlisted?* Please select an item.
Fax Phone Number:
unlisted?
Email:*
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High School and Year Graduated (Member)
High School and Year Graduated (Spouse)
Do you want your information posted in the Annual Directory?*
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Applicant 18 or older?*
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CZ/PC Affiliation:*
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If Retired, Please indicate year (Member)
If Retired, Please indicate year (Spouse)
Descendant of:*
Parents'/Relatives' Name and CZ/PC Affiliation*

Your credit card will be billed the amount of $200.00 to join the Governor's Club.

Please provide the following billing information: Please enter your credit card information carefully. 


Payment Information
Card Type:* Please select an item.
Card Number:* A value is required.Invalid format.Exceeded maximum number of characters.Minimum number of characters not met.
Expiration Date:* A value is required.Minimum number of characters not met.Exceeded maximum number of characters. MM/YY

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