Membership Form
(check/credit card info):
Feliciana Nature Society
P.O. Box 2866
St. Francisville, LA 70775
Form with Credit Card:
OR
OR ONLINE OUR SECURE SERVER
| Back to BirdFest | ||
| Feliciana Nature Society Membership Form | ||
| SEND WITH PAYMENT (check/credit card info): Feliciana Nature Society P.O. Box 2866 St. Francisville, LA 70775 |
Or Fax to 225-635-6421 Form with Credit Card: OR OR ONLINE OUR SECURE SERVER |
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Individual $10/yr
o
Charter Member $100 - lifetime o Family $20/yr o Charter Family $150 - lifetime (Spouses plus any children) o Corporate $30/yr o Corporate Charter $250 - lifetime
ENCLOSED IS $______
Credit card #___________________________________Expiration date_________________ (month/yr) Authorized Signature___________________________________________________ FULL NAMES OF EVERYONE IN THE HOUSEHOLD ADULT:______________________________________________
Employer__________________________________ ADULT:_______________________________________________
Employer____________________________________ CHILD:_____________________________ Birth date________ CHILD:____________________________ Birth date________ CHILD:_____________________________ Birth date________ CHILD:__________________________ Birth date________ PERSON FILLING OUT THIS FORM________________________________________________________ HOME PHONE: (____)________________________________ E-MAIL:______________________________ ADDRESS_______________________________________________CITY________________________ST______ZIP_________ o Please send me information on ¨ Volunteer opportunities ¨ |
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