Earth Day Indiana Online Membership Form

Anyone can be a member of Earth Day Indiana and help support environmental awareness. Just complete this form and send it in with your contribution.

To use our online form, simply highlight and copy the text, and paste it into Microsoft Word. If the form doesn't paste the way you want it, select special in the edit menu and paste the text as either styled or unformatted.

You may submit the form with payment to earthdayindiana@comcast.net or PO Box 40655, Indianapolis, IN 46240.

Your name________________________________________________________

E-mail address_____________________________________________________

Home phone__________________________ Cell_________________________

Address, city, state, zip_______________________________________________

I want to be a member of Earth Day Indiana one of these levels:

Preserver $100; Sustainer $50; Nurturer $35; Seed Planter $10; Student/Senior $5; Other $___________

Total Contribution = $_________

Periodically, we are able to obtain subscriptions of E Magazine at a promotional rate. If they are available, we provide subscriptions to E Magazine for people who donate $35 or more. If your donation is at or above the $35 level, do you want an E Magazine subscription? ___Y ___N

Would you like to volunteer to help with the festival? ___Y ___N

Earth Day Indiana does not sell or share our members' information with anyone.

Earth Day Indiana is a nonprofit organization. Contributions are tax deductible to the extent allowed by law.

Please make checks payable to Earth Day Indiana Inc.

Send forms and checks to PO Box 40655, Indianapolis, IN 46240

Or pay by credit card and e-mail the form to earthdayindiana@comcast.net:

___Visa ___MasterCard ___American Express ___Discover

Card number____________________________________ Exp._________