Chehalis River Basin Land Trust
Membership Application
Date: _____________________
Name: _______________________________________________
Address: _____________________________________________
_____________________________________________________
Phone: (H) __________________ (W) ____________________
Email_________________________________
Membership Level:
$ 500 Golden Steward
$ 100 Benefactor
$ 50 Patron
$ 30 Family
$ 20 Individual
$ 10 Living Lightly
I would like to make an additional contribution to the Stewardship Fund.
Amount enclosed ________________
Please contact me to become involved in land trust activities.
" Yes " NoPlease return to: Chehalis River Basin Land Trust
417 North Pearl Street
Centralia, WA 98531
Email: chehalislandtrust@yahoo.com
The CRBLT is a 501(c)(3) organization, and all contributions are tax-deductible to the extent allowed by law.