Chehalis River Basin Land Trust Membership Application
Date: _____________________
Name: _______________________________________________
Address: _____________________________________________
_____________________________________________________
_____________________________________________________
Phone: (H) __________________ (W) ____________________
FAX: _______________________
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.