BLACK WARRIOR RIVERKEEPER MEMBERSHIP APPLICATION
Please complete and return to:
Black Warrior RIVERKEEPER
712 37th Street South
Birmingham, Alabama 35222

Names: (Please include the names of all the members of your household, so they can become members too!)

_______________________________________________________________________

Address: _________________________________________________________________

_______________________________________________________________________

Phone: __________________________________________________________________

E-mail: __________________________________________________________________

Special Interests: ___________________________________________________________

PLEASE CHECK A CATEGORY
 
__________ Redfin Darter  ................................................. $25
 
__________ Warrior Darter ................................................. $50
 
__________ Tuskaloosa Darter .............................................. $100
 
__________ Watercress Darter .............................................. $250
 
___________ Vermilion Darter ................................................. $1000
 
__________ OTHER  (Please List) ........................................................ $__________

Please make checks payable to: Black Warrior  RIVERKEEPER  --  Black Warrior Riverkeeper is a 501(c)(3) tax-exempt charitable organization. Your contribution or membership is tax deductible to the extent allowed by law. No goods or services of monetary value will be provided in exchange for this contribution.