Westmoreland Bird & Nature Club

Membership Application

Name:________________________________________________


Address:_____________________________________________


        _____________________________________________


City, State Zip:_____________________________________


Phone Voice (optional):______________________________


Phone Fax (optional):________________________________


Email (optional):____________________________________


Home Page (optional):________________________________


To join the Westmoreland Bird & Nature Club please send check
or Money Order, made out to Westmoreland Bird & Nature Club, to:

	Rose Tillmann
	PO Box 188
	New Derry, PA 15671

$7 individual/family. $20 supporting membership.
Include your name and address for the mailing list.
Phone number and other information is optional.

All Membership Dues are due in January, unless you joined after
September 1st.

Enclosed is my payment for membership in the Westmoreland Bird & Nature Club.

Checkmark where appropriate:

   ____I am a new member

   ____I am renewing my membership

   ____I am renewing my membership & my mailing address has changed