Signup Form

Putnam Park FANS Membership Form

Join or renew your membership for the Friends & Neighbors of Putnam Memorial State Park!
Name *

Prefix First Name Last Name Suffix
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Home Number

Area Code Phone Number
Cellular Number

Area Code Phone Number
Membership level

Please choose your contribution. Rewards for higher membership levels coming soon - you will have an opportunity to vote on them in the near future!You can also select how many recurring payments you wish to authorize. Selecting "1" will only authorize this year's payment, "2" will authorize this year's and next year's, etc. This will save you from needing to manually renew, and you can always contact us to cancel future payments if needed.

Select membership: *

Scout level membership ( $ 10.00 for each year )

Recurring payments

Individual membership ( $ 20.00 for each year )

Recurring payments

Family membership ( $ 35.00 for each year )

For a single household

Recurring payments

Patriot membership ( $ 50.00 for each year )

Recurring payments

Loyalist membership ( $ 75.00 for each year )

Recurring payments

Captain membership ( $ 100.00 for each year )

Recurring payments

Colonel membership ( $ 250.00 for each year )

Recurring payments

General (Lifetime) membership ( $ 1,000.00 for each year )

Recurring payments

Putnam Park FANS Membership Form