Mattole Restoration Council: Printable Membership Form

To join the Mattole Restoration Council, simply print this page, fill in, and send payment to:

Mattole Restoration Council
P.O. Box 160
Petrolia, CA 95558

Name (or two names for family membership):
Address:
City, State and Zip:
Telephone:
E-mail Address:

1) I/we live or own property in the Mattole watershed: ___Yes ___ No
2) This payment is for: ___New Membership ___Renewal ___Just Donating! (skip to #4)
3) Please select a membership level: ___Individual $25 ___Family $40 ___Low Income $15
4) YES! I would liketo make an additional tax deductible donation: Amount $_____
5) Total amount enclosed (#3 + #4) $_____
6) ___Please contact me about additional ways to give to the MRC, including donations of stock, property and planned giving.

Select Payment method:

Check
Money Order
Credit Card (Mastercard and Visa only)

________________________________________________________________________
For Credit Card only:

Circle one: Mastercard Visa

Credit Card Number: ______-______-______-_______
Expiration Date___________________