Membership
Form
Please print, complete, and mail
with payment or use the links
below to
pay online using a secure server.
NAME
________________________________________________________________________
AFFILIATION
__________________________________________________________________
ADDRESS_____________________________________________________________________
CITY, STATE,
ZIP
_______________________________________________________________
PHONE: ______________________________________________________________________
FAX:_________________________________________________________________________
E-MAIL:
_________________________________________________________________________
Membership
Category
Circle or Click
Your Payment
One-Year Individual
Forum Membership $35 [Benefits of
Membership]
One-Year Student
Membership $15
One-Year Corporate
Membership $100
TOTAL ENCLOSED
$______
Please make checks out to the New York State Wetlands Forum, Inc.
EIN# 14-1723859. Mail checks and this form to New York State Wetlands Forum,
Inc., P.O. Box 1351, Latham, NY 12110-1351, or fax to
518-783-1258.
4
Youngs Place
P.O. Box 1351
Latham, NY 12110-1351
518-783-1322
Fax: 518-783-1258
info@wetlandsforum.org
Membership Form
NAME
AFFILIATION
ADDRESS_____________________________________________________________________
CITY, STATE,
ZIP
PHONE: ______________________________________________________________________
FAX:_________________________________________________________________________
E-MAIL:
| Membership Category | Circle or Click Your Payment |
| One-Year Individual Forum Membership $35 [Benefits of Membership] | |
| One-Year Student Membership $15 | |
| One-Year Corporate Membership $100 | |
| TOTAL ENCLOSED | $______
|
4
Youngs Place
P.O. Box 1351
Latham, NY 12110-1351
518-783-1322
Fax: 518-783-1258
info@wetlandsforum.org