FRIENDS OF PENNYRILE STATE FOREST AND PENNYRILE STATE PARK
MEMBERSHIP APPLICATION FORM (Membership will be for one (1) calendar year beginning January 1)
Please indicate the membership contribution you wish to make:
Student: $ 5.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Individual: $20.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Family: $35.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Business:
Supporting: $125.00 – 299.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Contributor: $300.00 – 499.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Donor: $500.00 – 999.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Patron $1,000.00 – 9,999.99 . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Benefactor: $10,000.00 & over . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________
Total Enclosed . . . . . . . . . . . . . . . . $ __________ Please list your contact information:
Name __________________________________________________________________
Street Address ___________________________________________________________
City ___________________________________________________________________
State ___________________________ Zip Code ______________________________
Phone Number ( _____ ) __________________ E-mail Address ___________________
Please print out and complete this form and make your check payable to:
Friends of Pennyrile P.O. Box 203 Dawson Springs, KY 42408 |
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