River Guardian Foundation
Membership Application
(Please Print)
Contact Information
Full Name: _________________________________________________________________________________________
Address: __________________________________________________________________________________________
City: _______________________________________ State: ______________ Zip: __________________
Phone: (Home) __________________ (Work) _________________________ (Cell) __________________
E-mail: ___________________________________________________
Please Select A Membership Level
Is your application for a new membership ______ or renewal of an existing membership? ______
Student and senior citizen membership - $10 _______
Standard single membership - $25 _______
Family and affiliate membership - $35 _______
Corporate membership - $50 _______
Payment Method
Credit Card: ___ American Express ___ Visa ___ MasterCard ___ Discover ___ Other
Card number: ____________________________________________ CSC code: ___________
Exp. Date: ______________ Signature as it appears on card: ________________________________________
(Note - credit card information will be destroyed once payment is processed)
Check: ____ (Please make payable to River Guardian Foundation)
Please print this form, complete and return to: River Guardian Foundation, P.O. Box 97003, Raleigh, NC, 27624-7003
On-line payment via Donate link below: ____
Membership Application
(Please Print)
Contact Information
Full Name: _________________________________________________________________________________________
Address: __________________________________________________________________________________________
City: _______________________________________ State: ______________ Zip: __________________
Phone: (Home) __________________ (Work) _________________________ (Cell) __________________
E-mail: ___________________________________________________
Please Select A Membership Level
Is your application for a new membership ______ or renewal of an existing membership? ______
Student and senior citizen membership - $10 _______
Standard single membership - $25 _______
Family and affiliate membership - $35 _______
Corporate membership - $50 _______
Payment Method
Credit Card: ___ American Express ___ Visa ___ MasterCard ___ Discover ___ Other
Card number: ____________________________________________ CSC code: ___________
Exp. Date: ______________ Signature as it appears on card: ________________________________________
(Note - credit card information will be destroyed once payment is processed)
Check: ____ (Please make payable to River Guardian Foundation)
Please print this form, complete and return to: River Guardian Foundation, P.O. Box 97003, Raleigh, NC, 27624-7003
On-line payment via Donate link below: ____
Please tell us what we may say about your donation.
You may acknowledge me as follows:
In a paper newsletter mailed to members: ____ In an e-mail newsletter: ____
In a newsletter posted on the web site: _____ In an annual report: _____
Please give us additional instructions on how we should handle your personal information:_______________________
_________________________________________________________________________________________________
You may acknowledge me as follows:
In a paper newsletter mailed to members: ____ In an e-mail newsletter: ____
In a newsletter posted on the web site: _____ In an annual report: _____
Please give us additional instructions on how we should handle your personal information:_______________________
_________________________________________________________________________________________________
The River Guardian Foundation is a 501(c)(3) nonprofit organization. Your membership dues are tax deductible.
