Name: ___________________________________________________________
Address: _________________________________________________________
Email: _________________________________________________________
Phone: _________________________ New? ______ Renewal? ______
Gift Membership Sent To: _________________________________________
Address: _________________________________________________________
Phone: _________________________ New? ______ Renewal? ______
Checks gladly accepted, made out to WRVHS.
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or you may pay by credit card
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Visa/MasterCard Number: __________________________________________
Expiration Date: __________________________
Signature: _______________________________________________________
Remember, memberships above the Steward level nclude a tax deductible contribution, and that gifts to the Annual Fund do noti include a membership.