Harry C. Barnes Memorial Nature
Center 
Indian Rock Nature Preserve
Hart Nature Reserve
Shepard
Nature Preserve
Shangri-La
Preserve
Corporate Membership Application
Name: ______________________________________________
Address: ______________________________________________
City, State, ZIP ______________________________________________
Phone: ______________________________________________
Corporate Membership Classes:
________ Benefactor $5,000.00
________ Patron $2,500.00
________ Sustaining $1,000.00
________ Sponsor $ 500.00
________ Donor $ 250.00
________ Friend $ 100.00
I grant permission for the Environmental Center to use our company’s name and membership class for use in publications, brochures, wall plaques, and other media to acknowledge our membership.
□ I do not want our company’s name used in acknowledgement of our membership.
_________________________________________ _____________
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Company Representative |
Date |
_________________________________________
Printed Name of Company Representative
Your contribution is tax deductible as allowed by law under section 501 (c) (3) of the Internal Revenue Service Code.
Please make contributions payable to: ELCCT
501 Wolcott Rd.
Bristol, CT 06010