Membership Forms

Send this form and check payable to the Brillion Nature Center to:

Brillion Nature Center

PO Box 85

Brillion, WI  54110

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—$20                                ________ Senior Citizen/Individual (62 years +) - $10

                ________ Family—$25                                                ________ Business/Organization* - $200

                ________ Student—$10                                                ________ Lifetime (single) - $250

                                                                                                                    *This memberships does not allow voting privileges.

 Additional donation in the amount of $_________.