Membership Application

Renewing Member: New Member: Gift Membership: (pls fill in gift recepient information below)
Name:
Address:
City/State/Zip:
Phone:
Email:
Work Location (optional-helps us obtain funding):
Would you like someone to contact you about volunteering at the Nature Center?	Yes No

MEMBERSHIP DUES
Student $20 (1 parking decal)		Senior $20 (Age 62+, 1 parking decal)
Basic $40 (1 parking decal, NEW Rate '09)		Premium $65 (2 parking decals)
Military Basic $30 (ID - 1 decal)		Military Premium $60 (ID - 2 decals)
Life Balance $20 members only w/ID (2 decals)		$15 Extra decal for premium members only
I would like to support the Nature Center with an additional tax deductible contribution in the amount of:

GIFT RECEIPIENT INFORMATION
Name:
Address:
City/State/Zip:
Phone:
Email:

Any other thoughts, special needs or questions?

Once we receive your information, you will be contacted by email to answer questions you may have regarding your membership.

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