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: ___________________________ NSS Number (optional): ________

Birth Date (optional for adults)_____________________________________

Address: _____________________________________________________

City: _____________________   State: ________ Postal Code: __________

Country, if not USA: _____________________________________________

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.