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DVRC Membership Application

Read the details about the Delaware Valley Raptor Center's Membership Program here.
    (http://www.dvrconline.org/membership.html)

Print and mail this page including a check or money order to:

Delaware Valley Raptor Center
416 Cummins Rd.
Milford, PA  18337

Make checks payable to DVRC.
If you need further information call (570) 296-6025 or email dvraptors@yahoo.com


Name______________________________________    Telephone __________________

Address _________________________________________________________________

City _____________________________________  State _____  Zip ________________

checkbox.gif (904 bytes)  Gift for ________________________    Age (if child) _______  From ____________________

Card signed   checkbox.gif (904 bytes)  Happy Birthday    checkbox.gif (904 bytes)  Merry Christmas   checkbox.gif (904 bytes)  Other  ___________________

Red checkbox gifPlease check applicable boxes:

checkbox gif(106 bytes)  New Member   OR    checkbox gif(106 bytes)  Renewing Member

checkbox gif(106 bytes) Student  $20.00     checkbox gif(106 bytes) Individual   $25.00    checkbox gif(106 bytes) Family  $30.00   checkbox gif(106 bytes) Supporting   $50.00   

checkbox gif(106 bytes) Sponsor $100 - $500    checkbox gif(106 bytes) Sustaining   $500 - $1000    checkbox gif(106 bytes) Patron  $1000 and over

We thank you for your support!
http://www.dvrconline.org

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