(print and use this page for your application)

Westmoreland Bird & Nature Club

Membership Application


Name:____________________________________________________________


Address:_________________________________________________________


        _________________________________________________________


City, State Zip:_________________________________________________


Phone(s) Voice (optional):_______________________________________


Phone Fax (optional):____________________________________________


Email (optional):________________________________________________


Home Page (optional):____________________________________________


To join the Westmoreland Bird & Nature Club please send check
or Money Order, made out to Westmoreland Bird & Nature Club, to:

	Rose Tillmann
	PO Box 188
	New Derry, PA 15671

$7 individual/family. $20 supporting membership.
Include your name and address for the mailing list.
Phone number and other information is optional.

All Membership Dues are due in January, unless you joined after
September 1st.

Enclosed is my payment for membership in the Westmoreland Bird & Nature Club.

Checkmark where appropriate:

   ____I am a new member

   ____I am renewing my membership

   ____I am renewing my membership & my mailing address has changed

   
How did you hear about the WBNC? _________________________________________

__________________________________________________________________________


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