Membership Form

To become a member, complete this form and enclose your membership dues.  Please fill it out exactly as you wish it to appear in our records.  Memberships are tax deductible under section 501(c)(3) of the IRS tax code. 

 

The renewal period for all memberships is February 1st.

 

Please check membership level:

 

            ____ INDIVIDUAL ($30)                               ____ PATRON ($160 TO $500)

____ FAMILY ($60)                                       ____ BENEFACTOR ($500 and above)

____ SPONSOR ($75)                                  

 

       

 

      

 

 

 

__________    ____________________   _____________________________      ____________________  

SALUTATION                FIRST NAME                                      LAST NAME                                                          EMPLOYER

 

________   __________________   _________________________     __________________

SALUTATION              SPOUSE FIRST NAME                      SPOUSE LAST NAME                                          EMPLOYER

 

____________________________   ___________________   _____   ____________

STREET                                                                                CITY                                 STATE         ZIP CODE

 

____________________                    ____________________

                                EVENING PHONE #                                                                DAY PHONE #

 

__________________________________________________________________________

E-MAIL ADDRESS

 

Youth Member’s Name:   1.______________   2.______________   3.______________

 

_____    I am enclosing $5 for First Class mailing of all correspondence.  Recommended for non-Bristol  residents to ensure         prompt delivery of program information. 

 

 

I am willing to volunteer for:  __Office  __Barnes Open Hours  __Events  __Facilities  __Program Asst.  __Bulk Mailing

 

 

 

                                                            Membership Privileges

                                1.  Entitles member to free admission to Barnes Nature Center public open hours.

                                2.  Lending privileges at The Sylvester Nature Library located at Barnes Nature Center

                                3.  Entitles member to participate in Indian Rock Summer Camp.

                                4.  Family level and above members receive birthday party discount.

                                5.  Convenient e-mail notification of events and classes.

 

Please make check payable to:          ELCCT

                                                                                501 Wolcott Rd.

                                                            Bristol, CT  06010

 

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