John Burroughs Natural History Society Membership Form

 

Membership Type (circle one):     Individual     Family

Check one:    ___Renewal or    ___New Membership

Name: _________________________________________________

Address: _______________________________________________

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Phone: ___________________________

Do you want "Chirp" sent by email: (circle one):        Yes        No

Email Address: ___________________________

Special Interests:_______________________________________________________

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To join the Society, mail a check for the dues to the Treasurer at:

Evelyn Rifenburg
10 Lark Drive
Woodstock NY 12498
845-679-2642

Dues are $15 per year for either an individual or a family.