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Please print and submit this form
with your check payable to:
Westport River Watershed Alliance (WRWA)
P.O. Box 3427,
Westport, MA 02790
Name: _______________________________________________________________
Address: _____________________________________________________________
City, State, Zip: ________________________________________________________
Tel # __________________________ E-Mail: _____________________________
Check one of the following boxes:
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$40
Friend of the Watershed |
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$100
Contributor to the Watershed |
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$250
Steward of the Watershed |
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$500
Guardian of the Watershed |
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$1000
Benefactor of the Watershed |
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$_____ Other |
Charge your membership on Mastercard, Visa, AMEX, DISC
| Type of Card (circle): Mastercard, Visa, AMEX, DISC |
| Amount $ |
Exp. Date: |
| Card Number: |
| Name on Card: |
last 3 digits (code on back) (AMEX 4 digits on front) |
Billing address if different than above: |
The Westport River Watershed Alliance is a membership-supported, 501(c)(3) nonprofit organization. All contributions are tax deductible.
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