Mail-in Membership Form Big Bend Sierra Club

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Join the Sierra Club today and receive this free Expedition Backpack!

Print this page, then fill out the information below.

First Name:	__________________________________________
Last Name:	__________________________________________
Address:	__________________________________________
	__________________________________________
City:	__________________________________________
State:	___________________	Zip Code:	_______________
Phone:	___________________	Fax:	_______________
Email:	__________________________________________

May we correspond with you via e-mail? Yes: ___ No: ___

From time to time, we make our mailing list available to other worthy organizations. If you prefer that your name not be included,
please check here: ___

Please select a membership level:

Individual Membership	Joint Membership
___ Introductory $25
___ Regular $39	___ Regular $47
___ Supporting $75	___ Supporting $100
___ Contributing $150	___ Contributing $175
___ Life $1000	___ Life $1250
___ Student $24	___ Student $32
___ Senior $24	___ Senior $32
___ Limited Income $24	___ Limited Income $32

Please select a payment method.

If you're paying with a personal check, please make it payable to the Sierra Club and send it to P.O. Box 52968, Boulder, CO 80322-2968.

AMEX: ___

Mastercard: ___

Visa: ___

Sierra Club MasterCard: ___
*
To apply for the card call 1-800-932-2775

Credit Card Number: _____ _____ _____ _____

Expiration Date (mm/yy): ________

___ Please do not send me the free expedition pack. I prefer that all of my contribution goes towards protecting America's environment.

Mail this page to:

Sierra Club
P.O. Box 52968
Boulder, CO 80322-2968

Thank you!

Contributions, gifts and dues to the Sierra Club are not tax deductible; they support our effective,citizen-based advocacy and lobbying efforts. Your dues include $7.50 for your subscription to Sierra Magazine and $1 for your Chapter newsletter.

* Sierra Club MasterCard is issued by MBNA America Bank, N.A.

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