Become a Member

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

Brillion Nature Center

315 South Main Street

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—$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 $_________.