Membership Form
(Fields marked in bold are required.)

Payment Method


Membership Level








Member Details

Please provide member name(s) as it should appear on the card.







Gift Membership (if applicable)

This is a gift membership for (provide name as it should appear on the card):




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Send Renewal Notice To:


Membership Total


Children's Scholarship Contribution (tax deductible)

 

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Mailing Instructions

Please mail your printed membership form along with a check for the total amount due to:
Lewis & Clark Foundation
P.O. Box 398
Great Falls, MT 59403