Make Check Payable to:
The Friends of the San Luis Valley National Wildlife Refuges
P.O. Box 857
Monte Vista, CO
81144

Circle one: New Member or Renewing

Date___________________

Name (Please Print) ______________________________________________________________________________

Street or P.O. Box ________________________________________________________ Apt_______________

City _______________________________ State ____________________ Zip _______________

Phone ______________________________ Email ____________________________________________________

Annual Membership Category:

__Senior (62+) or Student $10 __Individual $15 __Family $20 __Sponsor $50 __Best Friend $100+

__Life $1000+