2026 Annual MembershipPlease note: There is a 0% surcharge for debit cards, 3% surcharge for all other credit cards.Membership Level(Required)INDIVIDUAL: $35DUO: $40FAMILY: $50BENEFACTOR: $100SUSTAINER: $250PIONEER: $500PATRON: $1000GOLD PINEAPPLE CLUB: $2500Name(Required) First Last Secondary Name First Last Company NameAddress Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email PhoneTotal BENEFACTORWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 4×8 HERITAGE BRICK*** TEXT ONLY: Up to 21 characters per line 4 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPS OR TEXT & ICON: Up to 21 characters per line 2 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT ONLY)Brick: Yes (TEXT & ICON)No BrickWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 4×8 HERITAGE BRICK*** TEXT ONLY: Up to 21 characters per line 4 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPS OR TEXT & ICON: Up to 21 characters per line 2 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT ONLY)Brick: Yes (TEXT & ICON)No BrickPlease Choose IconS11: DoveS12: USA FlagS13: LeafS14: HeartLine 1: Please Input TextMaximum 21 Characters Per LineLine 2: Please Input TextMaximum 21 Characters Per LineLine 3: Please Input TextMaximum 21 Characters Per LineLine 4: Please Input TextMaximum 21 Characters Per LineWould you like to include a 3.5"x2" wood replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $25.00 Quantity Total SUSTAINERWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 8×8 HERITAGE BRICK*** TEXT ONLY: Up to 21 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPS OR TEXT & ICON: Up to 21 characters per line 6 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT ONLY)Brick: Yes (TEXT & ICON)No BrickWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 8×8 HERITAGE BRICK*** TEXT ONLY: Up to 21 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPS OR TEXT & ICON: Up to 21 characters per line 6 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT ONLY)Brick: Yes (TEXT & ICON)No BrickPlease Choose IconS11: DoveS12: USA FlagS13: LeafS14: HeartLine 1: Please Input TextMaximum 21 Characters Per LineLine 2: Please Input TextMaximum 21 Characters Per LineLine 3: Please Input TextMaximum 21 Characters Per LineLine 4: Please Input TextMaximum 21 Characters Per LineLine 5: Please Input TextMaximum 21 Characters Per LineLine 6: Please Input TextMaximum 21 Characters Per LineLine 7: Please Input TextMaximum 21 Characters Per LineWould you like to include a 4"x4" wood replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $25.00 Quantity Would you like to include a 4"x4" stone replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $35.00 Quantity Total PIONEERWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 12×12 HERITAGE BRICK*** TEXT ONLY: Up to 23 characters per line 9 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPS OR TEXT & ICON: Up to 23 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT ONLY)Brick: Yes (TEXT & ICON)No BrickWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 12×12 HERITAGE BRICK*** TEXT ONLY: Up to 23 characters per line 9 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPS OR TEXT & ICON: Up to 23 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT ONLY)Brick: Yes (TEXT & ICON)No BrickPlease Choose IconS11: DoveS12: USA FlagS13: LeafS14: HeartLine 1: Please Input TextMaximum 23 Characters Per LineLine 2: Please Input TextMaximum 23 Characters Per LineLine 3: Please Input TextMaximum 23 Characters Per LineLine 4: Please Input TextMaximum 23 Characters Per LineLine 5: Please Input TextMaximum 23 Characters Per LineLine 6: Please Input TextMaximum 23 Characters Per LineLine 7: Please Input TextMaximum 23 Characters Per LineLine 8: Please Input TextMaximum 23 Characters Per LineLine 9: Please Input TextMaximum 23 Characters Per LineWould you like to include a 4"x4" wood replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $25.00 Quantity Would you like to include a 4"x4" stone replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $35.00 Quantity Total PATRONWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 12×12 HERITAGE BRICK*** INCLUDES CUSTOM LOGO OR ICON Please upload/email your logo, if you do not have a logo, just email us and we will design one for you! EMAIL: Christina@Samplemcdougald.org Up to 23 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT & ICON)Brick: Yes (TEXT & LOGO)No BrickWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 12×12 HERITAGE BRICK*** INCLUDES CUSTOM LOGO OR ICON Please upload/email your logo, if you do not have a logo, just email us and we will design one for you! EMAIL: Christina@Samplemcdougald.org Up to 23 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT & ICON)Brick: Yes (TEXT & LOGO)No BrickPlease Choose IconS11: DoveS12: USA FlagS13: LeafS14: HeartFileAccepted file types: jpg, gif, png, pdf, Max. file size: 3 MB.Line 1: Please Input TextMaximum 23 Characters Per LineLine 2: Please Input TextMaximum 23 Characters Per LineLine 3: Please Input TextMaximum 23 Characters Per LineLine 4: Please Input TextMaximum 23 Characters Per LineLine 5: Please Input TextMaximum 23 Characters Per LineLine 6: Please Input TextMaximum 23 Characters Per LineLine 7: Please Input TextMaximum 23 Characters Per LineWould you like to include a 4"x4" wood replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $25.00 Quantity Would you like to include a 4"x4" stone replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $35.00 Quantity Total GOLD PINEAPPLE CLUBWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 16×16 HERITAGE BRICK*** INCLUDES CUSTOM LOGO OR ICON Please upload/email your logo, if you do not have a logo, just email us and we will design one for you! EMAIL: Christina@Samplemcdougald.org Up to 23 characters per line 9 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT & ICON)Brick: Yes (TEXT & LOGO)No BrickWould you like to include a brick with your annual membership?For a limited time, your Heritage Bricks are included with select membership levels. Personalized Heritage Bricks will be installed along the historic walkway of the Sample-McDougald House, honoring your family, celebrating significant milestones, or memorializing a loved one. ***Includes 12×12 HERITAGE BRICK*** INCLUDES CUSTOM LOGO Please upload/email your logo, if you do not have a logo, just email us and we will design one for you! EMAIL: Christina@Samplemcdougald.org Up to 23 characters per line 7 lines INCLUDED FREE OF CHARGE WITH NEW & RENEWAL MEMBERSHIPSBrick: Yes (TEXT & ICON)Brick: Yes (TEXT & LOGO)No BrickPlease Choose IconS11: DoveS12: USA FlagS13: LeafS14: HeartFileAccepted file types: jpg, gif, png, pdf, Max. file size: 3 MB.Line 1: Please Input TextMaximum 23 Characters Per LineLine 2: Please Input TextMaximum 23 Characters Per LineLine 3: Please Input TextMaximum 23 Characters Per LineLine 4: Please Input TextMaximum 23 Characters Per LineLine 5: Please Input TextMaximum 23 Characters Per LineLine 6: Please Input TextMaximum 23 Characters Per LineLine 7: Please Input TextMaximum 23 Characters Per LineLine 8: Please Input TextMaximum 23 Characters Per LineLine 9: Please Input TextMaximum 23 Characters Per LineWould you like to include a 4"x4" wood replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $25.00 Quantity Would you like to include a 4"x4" stone replica of your brick listed above? QuantityReplica fee’s are not included in membership rate Price: $35.00 Quantity Total