Otzinachson Group/Sierra Club
New Membership Mail-in Form

To mail in your membership form, just print
a copy of this form and send it to the address below.

The Sierra Club
P.O. Box 52968
Boulder, CO 80322-2968

Please fill out the information below:

First Name:
Last Name:
Address:
City:
State:
Zip: -
Phone:
Fax:
Email:

May we correspond with you via e-mail? Yes No

From time to time, we make our mailing list available to other worthy organizations.
If you prefer that your name not be included, please check here. 

Please select a membership level:

Individual Membership

Joint Membership
Introductory $25
Regular $39 Regular $47
Supporting $75 Supporting $100
Contributing $150 Contributing $175
Life $1000 Life $1250
Student* $24 Student $32
Senior $24 Senior $32
Limited Income $24 Limited Income $32

*For student memberships, please select one of the following:
Are you a:  College Student   High School Student
What year do you expect to graduate:

Please select a payment method:

Please include a personal check, payable to the Sierra Club
and send it to P.O. Box 52968, Boulder, CO 80322-2968.

MasterCard Visa
Credit Card Number:
Expiration Date(mm/yy):

Place my name on electronic mailing list to receive all my newsletters on-line.

Group Code: 4111

Contributions, gifts and dues to the Sierra Club are not tax deductible; they support
our effective, citizen-based advocacy and lobbying efforts. Your dues include $7.50
for your subscription to Sierra Magazine and $1 for your Chapter newsletter.

(Additional financial and regulatory information.)

Otzinachson Group of the Sierra Club