Scenic Virginia Membership
APPLICATION
Scenic Virginia, Inc. is a 501(c)(3) nonprofit corporation which allows your contribution to be tax deductible. You can read further
information about Scenic Virginia and other scenic organizations on the About Us pages.
Please print this form, complete it, and return it with your
check or money order payable to Scenic Virginia, Inc.
| Name: |
________________________________________ |
| Institutional Affiliation: |
________________________________________ |
| Street Address: |
________________________________________ |
| |
________________________________________ |
| City: |
________________________________________ |
| State: |
________________________________________ |
| Zip: |
________________________________________ |
| Telephone: |
________________________________________ |
| Fax: |
________________________________________ |
| E-mail: |
________________________________________ |
Do you have time to volunteer with Scenic Virginia?
Yes ___________
No ___________
ANNUAL MEMBERSHIPS:
| | | | |
| Individual | $25.00 | | Student | $15.00 |
| Household/Family | $50.00 | | Organization | $50.00 |
| Sponsor | $100.00 | | Patron | $250.00 |
| Benefactor | $500.00 | | Corporation | $500.00 |
| Scenic Virginia, Inc. ~ Attn: Leighton Powell, Executive Director ·
P.O. Box 17606 · Richmond, Virginia 23226 |
| Phone: (804) 282-5522 · Fax: (804) 282-5506 |
| ©
1999-2000 by Scenic Virginia, Inc. |
Email: email@scenicva.org |
| Last Updated: |
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