Mail-In
Membership Form

If you'd rather 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.

If you're paying with a personal check, please make it 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):

F99QE41091

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.

1-3-2004

Mail-In Membership Form

Mail-In
Membership Form