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Arboretum
Root Glen
Contact Information
Terry Hawkridge
315-859-4075 315-859-4407 (fax) |
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| ___ | Student |
$10.00 |
| ___ | Individual |
$50.00 |
| ___ | Family |
$75.00 |
| ___ | Supporter |
$100.00 |
| ___ | Benefactor |
$250.00 |
| ___ | Patron |
$500.00 |
| ___ | Lifetime Membership |
$1,000.00 |
| NAME:______________________________________ | ADDRESS:__________________________________ |
| CITY/STATE:________________________________ | ZIP CODE:_________________________________ |
| CLASS YEAR (IF A STUDENT):________________ | SCHOOL:__________________________________ |
| CREDIT CARD TYPE:_________________________ | E-MAIL ADDRESS:___________________________ |
| ACCOUNT #:_______________________________ | EXPIRATION DATE:_________________________ |
