MEMBERSHIP FORM

Friends of Vista House is a private non-profit organization with tax-exempt status.  Become a member of Vista House -- your membership card entitles you to a 10% discount at the Vista House gift shop and a newsletter.  All contributions are tax deductible. Print up this form, fill it in, then send to the address below.  Please make checks payable to: 

Membership Status:  [_]  New   [_]  Renewal

 Each year you join, there are the following levels of membership:

[_]  $10 - Junior (under 12)	[_]  $100 - Emerald	[_]  $2500 - Lazarus Society
[_]  $25 - Individual	[_]  $250 - Diamond	[_]  $5000 - Thor's Crown
[_]  $50 - Family	[_]  $500 - Crown Jewel	[_]  $ _____________ Other
[_]  $100 - $500 - Corporate	[_]  $1000 - Lancaster Circle

Credit Card: Visa ___ Mastercard ___ Discover ___ Amount__________________
(You may also send a check or money order)

Card No: ________________________________ Exp date:_______________________

Authorized Signature:______________________________________________________

 Address Information:

 Name:  ________________________________________________________________

 Email:  ________________________________________________________________

 Address:  ______________________________________________________________

 City:  __________________________  State:  ____________  Zip Code:  ___________ 

Telephone:  ___________________________________     Date:  __________________ 

YES!  I’d like to volunteer!

[_]   Interpretive/Information Desk    [_]  Committees   [_]  Board of Directors

Comments:  __________________________________________________________________