| Purchaser Name: | ________________________________________________________ |
| Purchaser Address: | ________________________________________________________ |
| Purchaser City/State/Zip: | ________________________________________________________ |
| Daytime Telephone Number: | ________________________________________________________ |
| E-mail Address: | ________________________________________________________ |
Is
this a [ ] gift item [ ] memorial, or an [ ] honorary gift [ ] Yes [ ]
No (If yes, complete section below. Appropriate notification will be forwarded.) |
|
| Name of Recipient or Honoree: | ________________________________________________________ |
| Mailing Address: | ________________________________________________________ |
| City/State/Zip: | ________________________________________________________ |
MEMBERSHIP
(check all that apply)
| [ ] $40 Cattail Kids (K-2nd grade) | [ ] $35 Individual |
| [ ] $45 Gator Gang (3rd-5th grade) | [ ] $50 Family |
| [ ] $50 Muskrateers (6th-8th grade) | [ ] $75 Contributor |
| [ ] $60 Creek Freaks (8th-12th grade) | [ ] $100 Academy Supporter |
| [ ] $60 Eagle Eyes Birding Club (3rd-12th grade) | [ ] $250 Bobcat Booster |
| [ ] $50 Eagle Eyes Birding Club (if member of another club also) | [ ] $500 Otter Associate |
| [ ] $1000 Cypress Society | |
| [ ] >=$2500 River Society |
MERCHANDISE
(check all that apply)
| T-Shirts | |
| Adult Long Sleeve (Tan only) $15 members; $18 nonmembers | |
| Size (check appropriate sizes) | Quantity (indicate quantity requested.) |
| [ ] XL | _______ |
| [ ] Large | _______ |
| [ ] Medium | _______ |
| Adult $12 members; $15 nonmembers | ||
| Size (check appropriate sizes) | Color (check color) | Quantity (indicate quantity requested.) |
| [ ] XXL | [ ] Green [ ] Blue |
_______ (not available in gold) |
| [ ] XL | [ ] Green [ ] Gold [ ] Blue [ ] Pine |
_______ |
| [ ] Large | [ ] Green |
_______ |
| [ ] Medium | [ ] Green [ ] Blue |
_______ (not available in gold) |
| Youth (Yellow only) $8 members; $10 nonmembers | |
| Size (check appropriate sizes) | Quantity (indicate quantity requested.) |
| [ ] Large | _______ |
| [ ] Medium | _______ |
| Ball Caps | |
| $15 members; $18 nonmembers | |
| Color (check color) | Quantity (indicate quantity requested.) |
| [ ] Khaki | _______ |
| [ ] White | _______ |
| [ ] Navy Blue | _______ |
| [ ] Black | _______ |
| Snowy Phinizy Swamp Poster |
| $10 members; $12 nonmembers |
| Quantity (indicate quantity requested.) |
| _______ |
| Nature Park Notecards |
| $8 members; $10 nonmembers |
| Quantity (indicate quantity requested.) |
| _______ |
| Nature Park Video |
| $15 members; $20 nonmembers |
| Quantity (indicate quantity requested.) |
| _______ |
| Visitor Guide |
| $8 members; $10 nonmembers |
| Quantity (indicate quantity requested.) |
| _______ |
SPONSORSHIPS
(check all that apply)
| [ ] Nature Park Fund | $200 |
| [ ] Adopt-a-Tree | $200 |
| [ ] Trail Sign | $250 |
| [ ] Bench | $600 |
| [ ] Kiosk | $2,000 |
| [ ] Outdoor Classroom | $5,000 |
| [ ] Observation Deck & Boardwalk | Please call for information |
| TOTAL PAYMENT ENCLOSED (Make check payable to SNSA. Credit Card payments are not accepted at this time.) Call Academy offices at 706 828-2109 to inquire about stock donation, or a contribution to the Endowment Fund. |
$___________ |
RETURN
TO: Southeastern Natural Sciences Academy 1858 Lock & Dam Road Augusta, GA 30906 |
|