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