BRANDY STATION FOUNDATION – 2010 MEMBERSHIP FORM

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Download the Adobe Acrobat version and complete it or this form , print it, and mail along with your check or credit card information to:

Brandy Station Foundation

P.O. Box 165

Brandy Station, VA 22714-0165

Yes, I support the work of the Brandy Station Foundation in preserving the natural and historic resources of the Brandy Station area of Culpeper County, Virginia. Please enroll me as a member of the Foundation.

 ___Enclosed is a check payable to: Brandy Station Foundation 

 ___ Charge my (VISA) (MasterCard) #: __________________________________ 

 Exp. Date:(mm/yyyy)_________ for $ _________

The name on this credit card is:________________________________________

My billing address is: ________________________________________________  

$25 2010 Membership              Additional Donation $______________

Name:_____________________________________________________________

Address:___________________________________________________________

City:___________________________________State:______Zip Code:_________

Please let me know how I can help as a volunteer. My contact/phone information is:

Phones:  Daytime:_____________________

                      Night:_____________________

                         Cell:_____________________

Email:_______________________________

Send my newsletter by email or postal service. (circle one)

The Brandy Station Foundation is a 501(c)3 non-profit, community-based membership group dedicated to preserving the natural and historic resources of the Brandy Station area of Culpeper County, Virginia. It relies on tax-deductable donations to meet its goals.