Membership Form for Audubon Society of New Hampshire

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	Membership

Become a Member of the Audubon Society of New Hampshire

Protecting New Hampshire’s natural environment is at the core of everything the Audubon Society of New Hampshire does. Add your voice to the thousands of people who want to protect wildlife and wildlife habitat, to see environmentally sound legislation coming out of Concord, and to provide environmental education for the state’s children and adults.
As a member of The Audubon Society of New Hampshire you will receive our bimonthly newsletter; automatic membership in your local chapter (where dozens of activities are offered); legislative alert information; discounts on store purchases, workshops and trips; and borrowing privileges at the F.B. White Library at Audubon House in Concord.

Complete the form below to join ASNH online using your credit card. If you would prefer to join by phone, or for further information, please call ASNH Membership at (603) 224-9909.

Blue Seal Feeds sponsors New Hampshire Audubon's membership program We thank Blue Seal Feeds for helping us to grow our membership through the donation of Birder'sSecret Neat Feast bird seed. Blue Seal Feeds offers a selection of Birder's Secret® specialty feed mixes as well as an extensive line of premium products formulated to attract a broad variety of feathered visitors. Visit them at: www.blueseal.com

Yes, I want to become a member!
Is this a NEW or a RENEWAL membership:
New	Renewal

Choose your membership level:
Senior/Introductory (1 year) - $24 Individual - $39 Family - $55 Donor - $75	Contributor - $100 Supporter - $250 Environmentalist - $500 Conservation Partner - $1000

Yes, I would like information on making gifts of stock, receiving income for life and saving both capital gains and income taxes.

My Contact Information
First name: (required)
Last name: (required)
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Address Line 2:
City: (required)
State: (required)
ZIP: (required)
Phone number, with area code: (required)
Fax number, with area code:
E-mail address: (required)
(required - your request will not go through without this information)

Credit Card Payment Information
Type of Card:
Cardholder's Name:
Card Number:
Expiration Date:	month year
Card ID Number:
The Card ID Number is found on the back of your VISA® or MasterCard®. Look for the last three numbers printed on the area where you sign your card - this is your Card ID Number. On your American Express® card, you can find it on the front, at the top right corner of the account number.
The Following Billing Address information should be completed only if your credit card statements are mailed to an address different from the one you provided above.
Billing Address Line 1:
Billing Address Line 2:
Billing Address City:
Billing Address State:
Billing Address Zip Code:

Audubon Society of New Hampshire
3 Silk Farm Road
Concord, New Hampshire 03301
Tel: (603) 224-9909
Fax: (603) 226-0902
email: asnh@nhaudubon.org

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