KBAS MEMBERSHIP/RENEWAL APPLICATION

Local Membership Dues

• Individual: $20
• Student and Seniors (62 and over): $15
• Family: $25
• Here is my tax deductible extra contribution for $              

Total Enclosed $              

   Check here if you are a current member of national Audubon
   Not sure of national membership status

Name                                                     

Address                                                                               

City/State                                                      ZIP         

Phone                            e-mail                                        

Klamath Basin Audubon Society Chapter Code: C9ZT600Z. Should you join National Audubon as a first time member, please use the above Chapter Code on your form - we receive additional $$.

Please contact me regarding:
   Gift memberships
   Volunteering for KBAS Committee activities

Make your check payable to KBAS and mail with this form to: KBAS, P.O. 354, Klamath Falls, OR. 97601