| Please indicate the membership contribution you
wish to make:
Student: $10 ....................................................
$__________
Senior (60+): $10 ............................................. $__________
Individual: $15 .................................................
$__________
Family: $20 ......................................................
$__________
Nonprofit Organization: $50 ................................ $__________
Business: $100 .................................................
$__________
Corporate: $500 ................................................
$__________
Optional additional contribution ........................... $__________
_______________
Total
Enclosed .............................. $__________
Please list your contact information:
Name _________________________________________________
Address _______________________________________________
City __________________________________________________
State _____________________ Zip Code ____________________
Phone Number (_______) _________________________________
E-mail Address __________________________________________
I would like to help with:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Please print, complete and return this form to:
Friends of McCormick's Creek State Park
P.O. Box 483
Spencer, Indiana 47460
Please make checks payable to:
Friends of McCormick's Creek State Park
(a not for profit organization)
|
