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
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 tax deductible donations to meet its goals.