Foundation of the

State Arboretum of Virginia

Online Membership Application Form (Please Print This Form)

If you have questions, please call 540-837-1758 Ext. 0 from 10-2 Monday-Friday

New Member_______ or Renewal________

Type of Membership:

_____ $35 Individual _____ $150 Sustainer

_____ $50 Family _____ $300 Benefactor

_____ $50 Nonprofit _____ $600 Life (Individual)

_____ $50 Business _____ $1000 Life (Dual)

_____ $1500 Corporate

Indicate Title: Mr./Mrs./Ms./Miss/Dr.

Name______________________________________________

Address ____________________________________________

City _______________________ State _____ ZIP ___________

Telephone: (_____) ________ ________________

E-mail: ____________________________

Please print this form and enclose a check or money order payable to FOSA and mail it to:

400 Blandy Farm Lane, Boyce VA 22620

Or provide credit card information below:

Type of Card ________MasterCard ________ VISA ________American Express ________ Discover

Card Number ________________________ Expires: __________

Cardholder's Name: (Please print) _____________________________________

Cardholder's Signature: ______________________________________________

Please send information on volunteering:

______ Gardens ______ Tour Docent

______ Our Shop ______ Special Events

______ Bulk Mailing ______ Fund Raising

______ Other

(Please explain your area of interest or expertise:

_________________________________________________________

I do not wish to join the Foundation at this time
but please accept my tax-deductible donation of $_____.

Benefactor and Life Member dues are permanently invested in the FOSA endowment.

Last Updated January 18, 2007