Westmoreland Bird & Nature Club

Membership Application

Name:________________________________________________________


Address:_____________________________________________________


        _____________________________________________________


City, State Zip:_____________________________________________


Phone(s) Voice (optional):___________________________________


Phone Fax (optional):________________________________________


Email (optional):____________________________________________


Web Page (optional):________________________________________

To join the Westmoreland Bird & Nature Club please send check
or Money Order, made out to Westmoreland Bird & Nature Club, to:

	Rose Tillmann
	PO Box 188
	New Derry, PA 15671

$7 individual/family. $20 supporting membership.
Include your name and address for the mailing list.

All Membership Dues are due in January, unless you joined after September 1st.

Enclosed is my payment for membership in the Westmoreland Bird & Nature Club.

Checkmark where appropriate:

   ____I am a new member

   ____I am renewing my membership

   ____I am renewing my membership & my mailing address has changed

How did you hear about the WBNC? _________________________________________


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