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 $_________.