Millers River Environmental Center
Athol Bird and Nature Club
Membership form

This is a:
New membership
Renewal membership
Former member returning

Type of Membership?
Student ---- $5.00/yr
Individual $10.00/yr
Family ---- $15.00/yr
 
     * Contributer $25.00/yr
     * Patron $50.00/yr
     * Benefactor $100.00/yr
        * Levels "Contributor" and above include free ABNC decal.
       for outside of window
       for inside of window

  *   Starred fields are required
    Member name * 
    Street or P.O. Bx * 
    Town *  State *  Zip * 
    Phone Number(s)    
    Email address * 
     This is a gift membership from
   
   Please send a gift card yes no
I would like to make an additional donation
to the Millers River Environmental Center (MREC):
Amount $
Anything you would like to add...
 
Although we will begin to process your membership, it will not become active until the fees checked above have been received.

After you submit this form you will be given the opportunity to "Pay Now" through PayPal

Dues in excess of $10.00 and all donations are tax-deductible.

Make check payable to: Athol Bird and Nature Club

Send to:
Athol Bird and Nature Club
100 Main Street,
Athol, MA 01331

Pleae call us with any questions
978-248-9491

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