2016/17 Navigators Circle Membership Acceptance I/We accept the invitation to join the 2016/17 Navigators Circle. By making this tax-deductible contribution*I/We join with others in helping to carry out the work of the Santa Barbara Maritime Museum.Member NameYou may list my/our name on the 2016/17 Navigators Circle member rosterPlease specify if contribution is “in honor of ” or "in memory of"Please note name of representative and title if member is a business or organizationI/we wish to remain anonymous.*Contributions are tax deductible to the fullest extent allowable by lawPlease print your member name:"In honor of" or "in memory of " name:Name of representative and title:Gift RangeIt is my/our intent to contribute to the 2016/17 Navigators Circle the amount indicated below. I/we plan to pay this commitment as noted in Section Three below, but reserve the right to modify my/our payment schedule in the event of unforeseen circumstances.Select a gift rangeMark V $100,000 & AboveAdmiral $50,000 – $99,999Ranger $25,000 – $49,999Ironsides $10,000 – $24,999Tomol $5,000 – $9,999Islands $2,500 – $4,999Marina $1,500 – $2,499Explorer $1,000 – $1,499Mark V. Enter your Gift Range of $100,000 & AboveAdmiral Enter your Gift Range of $50,000 – 99,999Ranger Enter your Gift Range of $25,000 – 49,999Ironsides Enter your Gift Range of $10,000 – 24,999Tomol Enter your Gift Range of $5,000 – 9,999Islands Enter your Gift Range of $2,500 – 4,999Marina Enter your Gift Range of $1,500 – 2,499Explorer Enter your Gift Range of $1,000 – 1,499Your Contact InfoName* First Last The Maritime Museum acknowledges its donors in various publications; please notify us if you do not wish to be listed. Santa Barbara Maritime Museum is a 501 (c) (3) nonprofit organization: Tax ID # 77-0392953.Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneName First Last Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Please click "Submit" only once. If you do not receive a receipt, please email or call Michele at firstname.lastname@example.org or 805 456 8751 This iframe contains the logic required to handle Ajax powered Gravity Forms.