The Oregon Club of Eugene-Springfield

MEMBERSHIP FORM

P.O. Box 7725, Eugene, Oregon 97401
Telephone: (541) 484-7527 • Fax: (541) 484-4575

TYPE OF MEMBERSHIP NAME & E-MAIL ADDRESS ADDRESS(ES) / DAY PHONE /
BUSINESS PHONE		 AMOUNT
INDIVIDUAL      $75
FAMILY
(husband/wife & children)		     $100
COMPANY
(maximum of 4 -- supply names and addresses desired for mailings)		      $225
LIFETIME
(individual)		      $825
BIG GREEN BENEFIT CASH DONATION     $25


MEMBERSHIP DRIVE WORKER _____________________________________________

CHECK   VISA/MC # ________________________ EXP.____________________

SIGNATURE ______________________________________________________________

Please print out this form and complete it.
Mail or fax your application with your membership fee to
P.O. Box 7725, Eugene, Oregon 97401 | Fax: 484-4575

Thank You....and GO DUCKS!