Membership Donation Form

make an investment today

Protecting and caring for 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 places are protected today and for generations to come.

Name

First Name Last Name

E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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

Add to My Donation $ 10.00

$10 increments

Quantity
Item subtotal: $ 0.00

Total $ 0.00

Payment Method

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 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.