MEMBERSHIP FORM

 

 

Download the Adobe Acrobat version and complete it or this form , print it, and mail along with your check or credit card information to:

 

Brandy Station Foundation Membership Form


Please complete this form, print it, and mail along with your check or credit card
information to:
Brandy Station Foundation
P.O. Box 165
Brandy Station, VA 22714-0165


Yes, I support the work of the Brandy Station Foundation in preserving the natural and
historic resources of the Brandy Station area of Culpeper County, Virginia.
Please enroll me as a member of the Foundation. Memberships are for one year from the
check date (or credit card transaction date or date cash paid].


___Enclosed is a check payable to: Brandy Station Foundation


___ Charge my (VISA) (MasterCard) #: __________________________________
Exp. Date: (mm/yyyy)_________ for $ _________
The name on this credit card is :________________________________________
My billing address is: ________________________________________________


$25 Individual Membership ________________
$40 Couple Membership___________
$15 Student Membership (High School or College)____
Additional Donation $___________________


Name:_____________________________________________________________
Address:___________________________________________________________


City: ___________________________________State: ______Zip Code: _________


Please let me know how I can help as a volunteer. My contact/phone
information is:


Phones: Daytime:_____________________
Night:_____________________
Cell:_____________________
Email:_______________________________


Please send my BSF newsletter by email or postal service. (circle one)


The Brandy Station Foundation is a 501(c)-3 non-profit group dedicated to preserving the natural and
historic resources of the Brandy Station area of Culpeper County, Virginia. It relies on taxdeductible
donations to meet its goals. More information at: www.brandystationfoundation.com

.