MEMBERSHIP FORM

Please complete this form and submit electronically.
The Highlands Plateau Greenway, Inc. | P. O. Box 2608 | Highlands, NC 28741-2608
New Member| Renewal
*  = Required entry
  Member(s)
* (1) Title (Mr., Mrs., Miss, Ms., Dr., Rev., Other)
          First name
          Last name
    (2) Title (Mr., Mrs., Miss, Ms., Dr., Rev., Other)
          First name
          Last name
* Primary Mailing Address
         City, State, Zip Code
         Telephone
    Secondary Mailing Address (if applicable)
          City, State, Zip Code
         Telephone
          Dates at this address
    Country (if not USA)
*  Email Address (or write "None")
    Fax
    Subjects of Interest
    Where did you hear about HPG?

* GREENWAY ANNUAL DUES

$25 - Individual

$50 - Family

$100 - Sustaining Member

$250+ - Corporate Sponsor

$500 - Benefactor

Additional contribution $ 

*  Total $ (DUES + contribution)
*  Paid by check # in the mail
or by credit card below.
 
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The Highlands Plateau Greenway is a (501)(C)(3) organization.
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Last updated on September 9, 2011