Step 1 of 4 25% 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 MemberRenewalGift Membership (new members only)Membership Type*Regular Member ($15)Family Membership ($23)Senior Member age 65+ ($8)Senior Couple ($13)Individual Life Member ($250)Organization ($25)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) giving 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 & AddressName* First Last Partner / Spouse* First Last Additional Names(children or other family members)Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact InformationPhone*(please use format ###-###-####)Phone Type*homeworkcellEmail* Phone(please use format ###-###-####)Phone TypehomeworkcellEmail 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 TypehomeworkcellSecondary Email PaymentWould you like to make an additional donation? All donations are tax deductible. Any donation amounts aren't included in auto-renewal.Total Cost $0.00 Cardholder Address Same as previously specified Credit Card Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* Card Details Cardholder Name Your Email Address (to send a payment receipt)* Cardholder Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CAPTCHA
