Membership Form

BECOME A MEMBER

Thank you for committing to protect and care for the environmentally significant land and water in Waukesha County for future generations.

As a member of the Waukesha County Land Conservancy, you are helping to ensure that Waukesha County’s most irreplaceable natural areas are protected today and for generations to come.

Name*

First NameLast Name

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Membership (suggested starting donation of $100)*

USDDonation

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is this a Gift Membership?

YesNo

Gift Recipient Name

First NameLast Name

Gift Recipient Email

example@example.com

Gift Recipient Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Message to Include from Sender to Recipient:

*Environmentally Friendly Option: Check this box if you would like to receive membership materials electronically.

Yes! Save paper and send my membership card electronically via email.