Membership Form

* Required Field

Name:*

First

Last

Address:*
Street AddressCityState / Province / RegionPostal / Zip Code
Phone:*

Area Code

-

Phone Number

E-mail:
Is this a GIFT:*
YES
NO
Special Instructions:
Select One:*
New Member
Renewal
Membership:*
Family
Individual
Senior Individual (age 62)
Senior Couple (household)
Patron
Supporting
Enterpreneur
Corporate
Lifetime
Total:
Please send Beaver Tales Newsletter:*
E-mail
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Name(s) to appear on membership card:
1st Card:*
2nd Card:
If a GIFT, please enter where to send if different from member address
Street AddressCityState / Province / RegionPostal / Zip Code
You can choose a way to pay: Pay with PayPal or Pay with an online bank account, debit or credit card.
**Membership will be processed and mailed within 10-14 days.**
**Your gate card will be mailed to you.**
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