MEMBERSHIP APPLICATION:

Mail to:

Friends of Patuxent

National Wildlife Visitor Center

10901 Scarlet Tanager Loop

Laurel, MD 20708-4027

Please check the type of membership: Date: _______________

○ New ○ Renewal ○ Change of Address Only

□ Individual ($15 per year) □ Family ($20 per year)

□ Contributor ($50 per year) □ Sponsor ($100 per year)

□ Donation ONLY $____________

Name: ________________________________________

Address: ______________________________________

City: ____________________ State:_________ Zip:________

Phone: (_____) ______________________________

E-mail: _______________________________________

Please make checks payable to "Friends of Patuxent"

THANK YOU VERY MUCH!!