2013 Membership Application

First Name MI Last Name:
Title
Email
Home Phone Cell Phone
Mailing Address
City State Zip
How would you like to be listed on the public Member List?
(i.e. John Smith, Mr. & Mrs John Smith, John & Jane Smith, Smith Family)
 
  I do not wish to be listed.
2013 Contribution Level
Other Amount
Activities/Participation:
What would you be most likely to participate in?
Special Events (Winter Hike, Mape Sugaring, Etc.)
Education Visitor Center
Construction Historian/Scrapbook
Newsletter Membership
Leadership Event Planning
Poker Run Fundraising
Shoot the Hills (Photo Competition)
Shoppe the Hills (Arts & Craft Fair)
When the form is complete, please scroll to the right and click NEXT.
Review your form, then scroll to the right and click FINISH. This will take you to the secure online payment portal.
   - denotes required fields