To join, print the following form, fill it out and mail it with a check payable to: Brookline Bird Club to:
For Membership questions please send a note to Leslie Kramer, Membership Secretary
Leslie Kramer10 Adams Street
Medford, MA 02155
Name:_________________________________ Phone:_____________________
Family - Additional Names____________________________________________
Address__________________________________________________________
City:_______________________ State:________ Zip Code:_________-_______
9 digit zip code please
E-mail Address:_____________________________________________________
Is this a new membership?:_____________
Or a renewal?:____________________
How did you hear of the BBC? (check one)
BBC Home Page_____ MassBird_____ Friend_____ Other_____
Indicate amount enclosed:
2012 Annual Dues ($15.00 individual - $22.00 Family) __________
Life ($200.00) __________
Additional BBC Decal* – ($1.00 plus self-addressed, stamped envelope) __________
BBC Pin – ($6.00 each $5.00 + $1.00 postage) __________
Gift to Club** – (tax deductible) __________
BBC School Book Fund** (tax deductible) __________
Gift for 100th events** (tax deductible) __________
Total Enclosed: __________* One BBC Decal comes with new membership. - Membership runs from January to December
** If your company has a matching gift program, please include the filled out form with your membership
