Membership Form

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Name ________________________________________________________
Address ______________________________________________________
E-mail ______________________________________
Phone _______________________________ Date _________________

I want to receive the Land Trust newsletter only: ______ ($10 annually)

I want to be a full voting member of the Land Trust: ______ ($25 or more annually)

My company would like to be a corporate sponsor: _________ ($100 or more annually)
Please list the person above as the voting representive.