California Wilderness Coalition Wildland Advocate Membership Mail-In Form

Please print out this page, fill out the form and send to: CWC-WAs, 1212 Broadway, Suite 1700, Oakland, California 94612.

Name: ______________________________Ph:_____________

Address: _____________________________________________

Select one:

• Enclosed please find my Wildland Advocate Membership dues of $__________



• I would like to pledge $_______ per month via my credit card

Method of payment:

• ____ Check Enclosed



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