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We invite you to join the Bergen Swamp Preservation Society
Please print this form and send it with a check payable to
Bergen Swamp Preservation Society, Inc., P. O. Box 460, Bergen, NY 14416-0460
I (We) hereby apply for membership or make a contribution as follows:
| Annual Memberships |
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Permanent Memberships |
| ___ Student |
$5.00 |
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___ Life |
$250.00 |
| ___ Individual |
$15.00 |
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___ Patron |
$1000.00 |
| ___ Family |
$25.00 |
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| ___ Club |
$20.00 |
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| ___ Sustaining |
$50.00 |
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___ Contribution $________ |
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(please print)
| Name |
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| Address |
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| City |
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| State |
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| Zip |
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| Telephone |
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If this is a gift, please state name to be signed on card:
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