Appalachian
Cave Conservancy Membership and/or Gilley Capital Campaign
ACC is a 501 C 3 Tax exempt
Organization and your contribution is tax deductible.
Date: __________________________
Name:
___________________________________
Birth Date if under 18: ________
This
form is being used to give the family member information only. (No dues are
included) _______
Address: ____________________________________________________________
City:
_________________________
State: _______ Zip Code: _______________
Country,
if not USA: ___________________________________________________
Email:
______________________________________________________________
Home
Phone: ______________________ Cell phone:
________________________
Fax:
______________ Work Phone: ______________________________________
NSS
member? _________
Number: _______________________________________
If you
wish, list participation in any land trusts or cave related organizations:
__________________________________________________________________
Dues
and Contributions
|
Individual ACC Membership ___ $10 Regular Member
___ $25 Contributing Member ___ $50 Sustaining Member ___ $100 Benefactor Member ___ $ 250 Life Member ___ Other Amount __________ |
Organizational ACC Membership ___ $10 Regular Organization Member ___ $25 Contributing Organizational Member ___ $50 Sustaining Organizational Member ___ $100 Benefactor Organizational Member ___ Other Amount _______________ |
|
Family ACC Membership ___ $ 15
Family Membership
- Use a separate form
for personal information for each family member. Two people of the same immediate family living at the same address. Each addition immediate family member at the same address
is $5. + $__.00_ ( ___additional Family Members at $ 5 each ) |
|
|
Gilley Cave Capital Campaign: ________
Pledge for 2010 for the ACC Gilley Cave Capital Campaign ________
Attached contribution to the ACC Gilley Cave Capital Campaign ________ Yes, List my name
and state as a donor on the ACC website and publications. |
|
Total
enclosed: $__________
This form
may be downloaded. Mail to Stu Syms, Phone
828-696-4885:
Appalachian
Cave Conservancy, Inc.
84
Preserve Ct.
Hendersonville,
NC 28791-2803