Long Island Beach Buggy Ass'n. Inc.
2008 Membership Application

Name :___________________________________________________

Address :_________________________________________________

Phone:
(Home) __________________ (Business) ________________

Affidavit : I will uphold the code of ethics and abide by the
By-laws of the Long Island Beach Buggy Ass'n. Inc. at all times.

Signature: ______________________________________________

Date:___________________   LIBBA # 
(if applicable) : _____________
If you are signing up a new member, enter your membership # above.

Membership Dues:New Membership Individual or Family $35.00
(Membership Renewal Dues:Individual or Family -$25.00 yr)

 

Send Your Application Along With Your Check or Money Order To:
LIBBA . P.O. Box 816 . Patchogue, NY 11772-0816

Need an additional LIBBA plate? Send $5.00 + $2.00 S&H along with the application above.
Please note your membership number
(if applicable) on your check or money order.

Questions? Call the LIBBA Hotline: 1-866-LIBBA-58 (toll free)

JUNIOR MEMBERSHIP

LIBBA members interested in having their children become a junior member, ages 6-16
should submit a Junior Membership Application with the child's name, address & birth date. 
Please include your membership number. There is no charge for junior members !

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All rights reserved