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Membership/Donation Form

 

Name______________________________________________
Spouses____________________________________________
Address____________________________________________
City________________________________________________
State___________________ Zip_________________________
Phone______________________________________________
Email______________________________________________

Please indicate your desired membership/donation level:
____Family Membership = $20
____Contributing Member = $50
____Sponsor = $100
____Guardian = $200 +________
____Other Donation Amount ________

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Click the print icon above, fill out the printed form and mail along with your check to:

Modie Park Conservancy
702 Grelle Avenue
Lewiston, ID 83501

Thank you for your interest in the Modie Park Conservancy!