Membership Application

To become a member; print, complete and mail this form with your check to:

Clinton Community Nature Center P.O. Box 93 Clinton, MS  39060

Phone: 601-926-1104
Email: ccnaturecenter@gmail.com

Check one Membership Category Cost Student $5.00   Individual  $20.00   Family  $35.00   Contributing  $50.00   Supporting  $100.00   Life  $1,000.00   Family Life  $1,500.00  Small Business  $200.00   Club  $250.00

NAME:_________________________________________ Company: ______________________________ Address: ________________________________ City:_______________ State: ____ Zip: ______ Telephone: ______________________________ FAX: ___________________________________ Email: __________________________________