[click here to print this form out]
| Name
__________________________________________________ | Life Member |
$1000.00 |
| Address
__________________________________________________ | Benefactor | $
500.00 |
| City
__________________________________________________ | Conservator | $
250.00 |
State __________ Zip Code _________ | Patron |
$100.00 |
| Your gift is tax deductible. | Sponsor | $
50.00 |
| Family/friend | $
25.00 | |
| Sowams fund | ____________ | |
| Other | ________ |
Mail to:
Barrington Land Conservation Trust
P.O. Box 324
Barrington, RI 02806-0324