Appalachian
Cave Conservancy Membership Application
Use
this form to apply for membership in the ACC. ACC is a 501 C 3 Tax exempt
Organization.
This
form may be downloaded and sent as a hard copy to:
Appalachian
Cave Conservancy, Inc.
Stu
Syms
84
Preserve Ct.
Hendersonville,
NC 28791-2803
828.696.4885
Name:
___________________________
Birth Date (optional for
adults)_____________________________________
Address:
_____________________________________________________
City:
_____________________ State:
________ Postal Code: __________
Country, if
not
Alternate Address (optional)
______________________________________
Email (optional):
_______________________________________________
Website (URL) (optional):
________________________________________
Home Phone:
______________________ Fax (optional): ______________
Work Phone (optional):
__________________________________________
List
participation in any land trusts, cave conservancies, or cave related
organizations (optional):
______________________________________________________________
Other
information relevant to this application (optional): ____________________
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 Member
- Use a second form for
personal information. Two people of
the same immediate family living at the same address. Each addition immediate family member at the same address is $5. ___ $ 5 Additional Family Member - Use a third form for personal information. |
|