Be a Friend of Blackwater! Print off the following form and mail it to us
with your tax-deductible donation. We have 800+ members worldwide
and growing! Won't you join us?
Friends of Blackwater
Membership Application
Ms./Mrs./Mr.______________________________________________
Address__________________________________________
_________________________________________________
Telephone ________________________________________
Email address ________________________________________
(Note: Please include your email address if you would like to be added to our mailing list. We will not share
your email address with any other party.)
Annual Membership
(Circle type below)
Membership Level
(Circle one level from list below)
| Individual $15 |
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Family $20 |
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Student $5* (K-12) |
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| Heron $30 |
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Falcon $60 |
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Eagle $100 |
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| Sponsor $250 |
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Lifetime $1000 |
Payment Type
(Circle One)
| Check/Money Order |
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Visa |
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MasterCard |
Credit Card Number ________________________________
Exp. Date _______ (mm/yy)
CVV or CSV Number* __________
Signature ____________________________________________
(*CVV or CSV - VISA and MasterCard require the three-digit Card Verification Value
-- sometimes call Card Security Value -- in addition to the card number. This
number is typically found written on the right side of the signature line on
the back of the card.)
*If under 18, parent signature:__________________________________
Make checks and money orders payable to Friends of Blackwater
Mail form to Friends of Blackwater, Inc.
P.O. Box 1231, Cambridge, Maryland 21613
Or fax completed form to 410-221-7738
For additional information, contact Peggy Tillier at eaglesnest16@hotmail.com
Thank you!
Would you like to serve on a Friends Committee? If so, indicate
your interests below and we will provide you with more information
about how you can help.
______Budget and Finance
______Education and Training
______Personnel
______Bookstore Operations
______Publications
______Member Relations
______Public Relations
______Wildlife-Oriented Recreation
______Project Committee
______Hospitality