Name: ________________________________________________________________________
Address: ______________________________________________________________________
City: ____________________________________________ State: _________ Zip: ___________
Phone: (_______________)________________________________________________________
E-mail address: _________________________________________________________________
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Would you like the above information published on the NOS home page? _____Yes _____No
| ____ All Info | ____ Name Only | ____ Name/Phone | ____ Name/Email |
Student |
$10.00 __ |
Individuals |
$15.00 ___ |
Family |
$25.00 ___ |
Sponsoring (individuals or family) |
$50.00 ___ |
Sustaining (individuals or family) |
$100.00 ___ |
Lifetime (individuals) |
$250.00 ___ |
Newsletter sent via US mail instead of by electronic mail. |
$5.00 ___ |
Additional Donation |
____________ |
Total amount enclosed: |
______________ |
We strongly urge members to receive our newsletter online and join our email list. It helps us manage
the considerable effort required to distribute the newsletter and manage our expenses better. There are
many opportunities to receive timely information about local sightings and events that are only available
via electronic communication. Please be sure to provide your current email address above.
Make checks payable to: Natchaug Ornithological Society
Mail membership forms to: Natchaug Ornithological Society, PO Box 192, Mansfield Center, CT 06250
Print this form and return it with your check to the address above or bring it to the next NOS meeting.
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