Name: ________________________________________________________

Address: ______________________________________________________

Town/City _____________________________________________________

State ______________________________ Zip ________________________

Email ____________________________ Phone # _____________________

___ $25 donation, individual membership (annual)

___ $50 donation, family membership (annual)

___ $5 donation, student membership (age 18 and under, annual)

___ $500 donation, lifetime membership

___ Number of people in my family (for family memberships please include names).

___ Here is an additional donation of _____________________

___ I am interested in doing volunteer work in the following areas:

______________________________________________________________________

Please make checks payable to:
South Burlington Land Trust, Inc.

and mail to:
Michael Mittag (Treasurer)
8 Lincoln Green
South Burlington, VT 05403

THANK YOU FOR YOUR SUPPORT!

SBLT is a Vermont non-profit corporation and has tax exempt status under Section 501(c)(3) of the Internal Revenue Code. All donations to SBLT are tax deductible to the extent allowed by law.

Our membership year is September 1 - August 31.