California Wilderness Coalition Membership Mail-In Form

Please print out this page, fill out the form and send to:
California Wilderness Coalition
1212 Broadway, Suite 1700
Oakland, CA 94612

Name: ______________________________________Ph:___________________

Address: __________________________________________________________

City, State: _________________________________ Zip: ____________________

Annual Dues
Individual $30
Sustaining $50
Benefactor $100
Mojave $250
Big Sur $500
Non-profit $30
Business Sponsor $50
Contributer $10

Select one:

• Enclosed please find my membership dues of $__________



• Here is a special gift of $__________

Method of payment:

• ____ Check Enclosed



• ____ Bill my Credit Card
  
  No._______________________________ Exp.___________
  
  Signature_________________________________