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Send this form and check payable to the Brillion Nature Center to:
Brillion Nature Center Brillion Nature Center Membership and Donation Form Name ________________________________________________________________________ Address ______________________________________________________________________ City ______________________________________________ State _________ Zip _________ Phone _____________________________ Email ____________________________________ For new or renewing memberships, please check one category: ________ Adult/Individual—$15 ________ Senior Citizen/Individual (62 years +) - $8 ________ Family—$20 ________ Business/Organization* - $100 ________ Student—$8 ________ Lifetime (single) - $200 *This membership does not allow voting privileges. Additional donation in the amount of $_________.
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