2021 Alaska Charter Association Membership Form
PO Box 478, Homer, AK 99603
My Products
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Full Business/Captain Membership
$200.00
$
200.00
Captain Associate Membership (Business Must be Member)
$50.00
$
50.00
Quantity
Supporting Community Business Membership
$50.00
$
50.00
Client Supporting Membership
$20.00
$
20.00
Name
*
First Name
Last Name
Company Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
General Member Information
Information provided will be kept confidential for ACA use and will not be provided for any external marketing purposes.
My Email Address
*
example@example.com
Website Address
www.example.com
Closest Major Port
*
Anchorage
Cordova
Gustavus
Homer
Juneau
Ketchikan
Kodiak
Ninilchik
Petersburg
Seward
Sitka
Soldotna
Valdez
Whittier
Yakutat
Type of Business
*
Single Charter Operator
Multi-Charter Operator
Lodge Operation
Captain/Employee
Tackle Store
Hotel
Restaurant
Other
If Applicable, how many vessels in your business?
How many employees, including yourself?
Captain Associate Memberships - Must work for a business that is a member of ACA.
Captain Name
First/Last
Email Address
example@example.cxom
Captain Name
First/Last
Email Address
example@example.com
Captain Name
First/Last
Email Address
example@example.com
Captain Name
First/Last
Email Address
example@example.com
Please verify that you are human
*
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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