Online Membership Form

Friends of Five Rivers Membership

Membership

Annual Dues *

Student/Senior - $ 25.00

Individual - $ 35.00

Family - $ 50.00

Patron - $ 100.00

Benefactor - $ 200.00

Sustainer - $ 500.00

Total Amount

I want to contribute this amount every year

Email Address *

Member Information

First Name *

Last Name *

Address *

Address Line 2

City

State *

Zip Code *

Home Phone *

Cell Phone

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province

Postal Code

Additional Information

How did your hear about Friends?

I'd like to receive updates from friends

Mailing List

Yes No

I'd like to receive information on volunteer opportunities

Volunteer Opportunities

Yes No

Please include my name and support in Friends’ Annual Report.

Included in Annual Report