Bedford Audubon Membership Application
for Chapter Only
membership
Yes, I would like to join the Bedford Audubon Society. My
Chapter Only membership will help support local conservation
efforts, programs, and sanctuaries.*Print and fill out this form and mail with your check
payable to:
Bedford Audubon Society to:
Bedford Audubon Society
35 Todd Road
Katonah, New York 10536
or fill in your MasterCard of Visa credit card information
below. Please see
if your company has a matching gifts program! Please check the
membership category. [ ] New Member or Renewal…$30.00
[ ] Supporter………….$50.00
[ ] Gift Membership…...........$30.00
[ ] Contributor…..…$100.00
[ ] Student……………......………$15.00
[ ] Patron.……………$500.00 [ ] I wish to make an
additional donation of______________________
[ ] I do not wish to have my name or contact information shared with
outside organizations. Name______________________________________________________
Address____________________________________________________
City____________________________
State ______ Zipcode_________ [ ] This is a gift. Please
send membership to:
Name______________________________________________________
Address____________________________________________________
City____________________________
State ______ Zip_____________ Credit Card Information: [ ]
MasterCard [ ] Visa Name (as it appears on card)
__________________________________
Address____________________________________________________
City____________________________
State ______ Zipcode_________ Phone
____________________________________
Account# _______________________________ Expiration date ______
Security code (3 or 4 digit# on back of card near signature) _________
Signature _________________________________ Date _____________ |