Form

WCLC Membership

Protecting environmentally significant lands in Waukesha County.

Name

First Name Last Name

Address *

E-mail *

Phone Number *

- Area Code Phone Number

Donation *

Contributor $ 35.00

Sentinel $ 50.00

Guardian $ 100.00

Steward $ 250.00

Conservator $ 500.00

Benefactor $ 1,000.00

Total $ 0.00

Payment Method

Is this donation in. . .

Memory? Honor?

Please provide the NAME of the individual and (if you wish) the ADDRESS to where you would like a card sent.