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Membership Application for Friends of LBL

Name            _______________________________________

Street Address            ________________________________________

____________________________________________________

Phone Number            (_____) _______-______________

Email Address              _____________________________________________

Category of Membership

Individual Memberships

                                    Level 1            Level 2            Level 3

Student                         [  ]  $10      [  ] $15                                    

Individual                      [  ]  $35      [  ] $50             [  ] $100   

Family                           [  ] $50       [  ] $100           [  ] $250

Business Memberships

                                    Other                    Level 1            Level 2            Level 3

Business Partner                                        [  ]  $250         [  ] $500           [  ] $1,000            

Oak Leaf Partner          [  ] $5,000            [  ]  $25,000    [  ] $50,000      [  ] $100,000        

Eagle Partner                [  ] $250.000        [  ] $500,000   [  ] $750,000    [  ] $1,000,000

Special Gift $______________________

[  ] check is attached    [  ] bill me    [  ]  Visa card    [  ]  MC

Printed Name on Card __________________________________________

Card number __________________________________________

Expiration Date            __________________

________________________________________________

Signature of Cardholder

Please print out this form complete it and send it to:

Membership Coordinator

Friends of LBL

Land Between The Lakes Association

345 Maintenance Road

Golden Pond, KY 42211

Questions to jrufli@friendsoflbl.org or (270) 924-2077.

Please remember that ALL GIFTS and DONATIONS regardless of size make the efforts of Friends of LBL (Land Between The Lakes Association) possible.  No gift is unappreciated.