Mt. Lebanon Nature Conservancy Membership Form

Mt. Lebanon Nature Conservancy

Working to protect green space in Mt. Lebanon


Mt. Lebanon Nature Conservancy
Membership Form

Enclosed is my membership form and tax-deductible contribution.
Check appropriate line:

____Student: $1 ____Individual: $10 ____Family: $15
____Donor: $25 ____Contributor: $50 ____Sustainer: $100

Name:______________________________________________________


Street Address:_______________________________________________


City, State:__________________________________________________


ZIP Code:_________________________


Phone:____________________________


Email:____________________________


FAX:____________________________


Date:____________________________


I am interested in becoming a Conservancy volunteer (yes/no):_______

Mail this form and your check made out to "Mt. Lebanon Nature Conservancy"
to the following address:

Mt. Lebanon Nature Conservancy
P. O. Box 14901
Pittsburgh PA 15234

Thank you for your support!