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 [Benefits of Membership]
$ 35.00
One-Year Student
Membership
$ 15.00
One-Year Corporate
Membership
$100.00
TOTAL ENCLOSED
or
Click Here to Review Total
$______
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 [Benefits of Membership] | $ 35.00 |
| One-Year Student Membership | $ 15.00 |
| One-Year Corporate Membership | $100.00 |
| TOTAL ENCLOSED or Click Here to Review Total | $______ |
4
Youngs Place
P.O. Box 1351
Latham, NY 12110-1351
518-783-1322
Fax: 518-783-1258
info@wetlandsforum.org