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Membership Form

(Fields marked in bold are required.)

Please Select:

Please Select:$35 (Individual)
$55 (Family)
$100 (Bighorn Sheep)
$250 (Indian Pony)
$500 (Bison)
$1000 (Grizzly)
$1805 (1805 Society)

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

Member Name:
Address:
City:State:ZIP Code:
Country:
Home Phone: Work Phone:
Int'l Phone:
Email Address:

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

Member Name:
Address:
City:State:ZIP Code:
Country:

Send Gift Card To:

Recipient
Me

Sign Card:

Send Renewal Notice To:

Recipient
Me

Membership Fee:$

Children's Scholarship Contribution (tax deductible)

Contribution:$

Total Due:$

Verification:

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Please mail your printed membership form along with a check for the total amount due to:

Lewis and Clark Interpretive Center Foundation
P.O. Box 398
Great Falls, MT 59403