Association Membership Application

Name: ___________________________________________

Address: _________________________________________

City/State/Zip: _____________________________________

Telephone: _______________________________________

E-mail: __________________________________________

Class of membership (circle one):

• Student - $15
• Senior - $15
• California Quail - $25
• Snowy Egret - $55
• Great Blue Heron - $110
• Golden Eagle - $275
• California Condor - $500
• Life Membership - $1,000

Please Check One:

___Attached is my check for $____________.

___Please charge my membership fee of $____________ to the following credit card:

___Visa ___Mastercard

Card #____________________________________

Expires: Month______ Year______

Signature:_________________________________

Please mail this application and your check (if applicable) to:

PG Museum of Natural History Association
165 Forest Avenue
Pacific Grove, CA 93950

Remember: your contributions are tax deductible. Thank you for your support!