___ $10 donation, basic annual membership for one person.

___ $25 donation, basic annual family membership.

___ $25 donation, business membership.

___ Number of people in my family.

___ Here is an additional donation of _____________________

In order to make membership possible for all South Hero residents and friends, our membership dues are very low. If you are able to contribute more than the basic membership, your additional contribution is greatly appreciated. Thank you!

For more information on contributions to the Land Preservation Fund, call (802) 372-3786 or email info@shlt.org

Name: ________________________________________________________

Address: ______________________________________________________

Town/City _____________________________________________________

State ________________________ Zip _____________________________

Total Enclosed ______________________________

Please make checks payable to South Hero Land Trust

Summer Address. Is this a mailing address (Y/N) ______

Address ________________________________________

Summer Town/City _______________________________________

Summer State ____________________ Zip _______________