Membership Application
(Print out this form and mail it with your membership fee to the address listed below)

Please accept my membership application, so that I can help Clearwater in its efforts to clean up our environment and spread the important message of environmental health and protection.

[   ]  Individual - $25.00     [  ]  Family - $35.00      [  ]  Low income/Senior Citizen - $10.00

[  ]  Lifetime Individual  - $250.00       [  ]  Lifetime Family  - $400.00

[  ]  Sponsor - $100.00      [  ]  Contributing  - $50.00

[  ]  I am not yet a member, but would like to contribute to this worthy cause.
       My tax-deductible donation is $ ____________

Name: _________________________      Date: ______________

Address: _________________________________ City: _________________ State: ______

Zip Code:  _________________  Phone Number:  ____________________

Make tax deductible check or money order payable to: Monmouth County Friends of Clearwater and mail to:

M.C. Clearwater, P.O. Box 303, Red Bank, New Jersey  07701