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Membership Inquiry
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required)
Contact Information:
Salutation:
-- choose one --
Mr.
Mrs.
Ms.
First Name:
Last Name:
Email Address:
Street Address:
Apt./Suite:
City:
State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
District of Columbia
Zip Code:
Home Phone:
Cell Phone:
Demographic Information:
Marital Status:
-- choose one --
Married
Single
Cohab
Age Group:
-- choose one --
Under 21
21 - 35
36 - 50
51 - 65
65 +
Combined Annual Household Income:
-- choose one --
Less than 24,999
25,000 - 29,999
30,000 - 39,999
40,000 - 49,999
50,000 - 59,999
60,000 +
Primary Residence:
Own:
Rent:
Which of these credit cards do you own?
--None--
Visa
MasterCard
Amex
Discover
Additional Information:
How did you hear about us ?
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Search Engine
Travel Site
Previous Guest
Existing Member
Employee
Other
Please specify:
Please submit any additional questions or comments using the field below.
By submitting this membership inquiry form and providing my/our names and demographic information, I/We expressly consent, affirmatively request and agree to be contacted by telephone at the telephone number provided herein, including the use of an automated telephone dialer in which case a prerecorded message may be left on my/our answering machine and/or email by Erie Islands Resort & Marina, their affiliates, subsidiaries and partners concerning this inquiry, including but not limited to, the purchase of a timeshare and/or vacation package, if I/we meet Erie Islands Resort & Marina marketing demographics.
I have read and agree to the above terms.