| I wish to become a Circle of Friends member at the following level: | ||
| "Patron of Preservation" | $500 | |
| "Save the Farm Friend" | $250 | |
| "Save the Orchard Friend" | $100 | |
| "Friend" | $75 | |
| "Family Membership" | $50 | |
| "Junior Ranger" (Kids 12 and under; comes with membership card) | $5 | |
| "Other" | $_________ | |
| Personal Information: | ||
| First Name: | ________________ | |
| M.I.: | ____ | |
| Last Name: | ______________________________ | |
| Company: | _____________________________________________ | |
| Street Address: | ______________________________________ | |
| City: | _________________________ | |
| State: | ____ | |
| Zip Code: | __________ | |
| Phone Number: | ____-____-______ | |
| Ext.: | ______ | |
| E-mail: | ________________________________________ | |
| Credit Card Information | ||
| (Please note: So that every dollar counts towards preserving open space, a 3% handling charge is added to credit card donations to cover fees.) | ||
| Credit Card: | VISA, MasterCard, American Express, or Paypal | |
| Number: | ____________________ | |
| Exp. Date: | ____ / ____ (mm/yy) | |
| Check Information | ||
| Enclosed is my made payable to MCF in the amount of $ ______. | ||
| My employer matches gifts; please send me the necessary forms. | ||
| Please mail to: | ||
| Monmouth Conservation Foundation PO Box 4150 Middletown, NJ 07748 | ||