Join / Renew / Give "*" indicates required fields Step 1 of 4 25% Membership Registration InformationOur membership year is May through April. Dues paid after January 1 will be valid until May of the following year.Registration Type* New Member Renewal Gift Membership (new members only) Membership Type* Regular Member ($20) Family Membership ($30) Senior Member age 65+ ($15) Senior Couple ($20) Student age <21 ($15) Individual Life Member ($250) Organization ($35) Reciprocal Organization ($0) Gift Membership Type* Regular Member ($5) Family Membership ($5) Senior Member age 65+ ($5) Senior Couple ($5) Name of CURRENT MEMBER(s) making the gift* First Last Additional Name of CURRENT MEMBER(s) giving gift First Last Gift Membership Terms* Agreement of termsI understand that on the next pages I must complete the name, address, phone and e-mail information about the new member to whom I'm giving this gift. Hartford Audubon will then send my friend a gift announcement card and new member packet in an envelope with my name address as the sender. Name & Address of New or Renewing MemberName & Address of person receiving giftOrganization*Name* First Last Partner / Spouse* First Last Additional Names(children or other family members)Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Information. For New and Renewing Members this should be your own information. For Gift Memberships this should be the recipient's information.Phone*Phone Type* home work cell Email* Most of our members have their names, addresses, phone(s) and email(s) included in the annual member handbook. While names must always be included, you may choose to have your address, phone, or e-mail excluded. Excluded information will only be available to Hartford Audubon Officers and Membership.Exclude from member handbook Exclude address from handbook Exclude phone number from handbook Exclude email address from handbook Optional InfoOptionally provide secondary phone or email addresses.Secondary PhonePhone Type home work cell Secondary Email PaymentWould you like to make an additional donation? All donations are tax deductible. Total Cost
