Friends of the Horicon National Wildlife Refuge
Friends of the Horicon National Wildlife Refuge
Annual Membership Rates
Your membership is vital to our mission in providing support to the Horicon Marsh National
Wildlife Refuge. Please printout and complete this membership form and mail it in along with
your membership level contribution.

Name:_____________________________________________________________________

Address:___________________________________________________________________

City:______________________________________________________________________

State/Providence:________________________________________ Zip:_________________

Telephone no._______________________________________________________________

Email address:______________________________________________________________

PERSONAL MEMBERSHIP

_____ Student & Senior [$5.00]                        _____ Individual [$10.00]

_____ Family [$15.00]                                       _____ Corporation [$50.00]

_____ Lifetime [$250.00]                                  _____ Other Donation
                                                                            (donations are tax deductible)   
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GIFT MEMBERSHIP/MEMORIAL (please circle appropriate category)

Name:_____________________________________________________________________

Address:___________________________________________________________________

City:_______________________________________________________________________

State/Providence:________________________________________ Zip:_________________

Telephone no._______________________________________________________________

Email address:______________________________________________________________

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Enclosed is a:      _____ Check               _____ Money Order

Total amount enclosed:_____________________________
Make checks payable to:
Friends of the Horicon National Wildlife Refuge

Mail to:
Friends of the Horicon National Wildlife Refuge
W4279 Headquarters Road
Mayville, WI 53050 USA
THANK YOU FOR SUPPORTING THE HORICON NWR!