Please print this page, complete the form, and return it with a check, or credit card number and signature to:
Mendocino Coast Botanical Gardens
18220 North Highway One
Fort Bragg, CA 95437
Membership Name:_____________________________________________________________________
Address:_____________________________________________________________________________
City:_________________________________________ State: ________ Zip:__________________
Telephone (day): ________________________ Email address: ____________________________
Please enroll me at the following Membership level (check one):
___ Individual - $40
___ Senior Individual - $30
___ Household* - $60
___ Senior Household* - $50
___ Sponsor* - $100
___ Supporter* - $250
___ Contributor* - $500
___ Patron* - $750
___ Benefactor* - $1000
___ Donation - $__________
* Please list the two adults to be included in this membership:
____________________________________________________________________________________
____________________________________________________________________________________
Charge my (circle one):
Visa MasterCard Discover
Full Name ____________________________________
Card # ______________________
Expiration Date: ___/___/___
Signature ______________________