Rogue Valley
Audubon Society

Name: _________________________________________________________

Address: _______________________________________________________

Town: __________________________ State: _______ Zip: ________-______

Phone (optional): ______________ Email (optional): _____________________

Rogue Valley Audubon Society will not share your information with any other organization.

Circle if you are a:    New member    Renewing member

Would you like to receive a printed copy of The Chat, our newsletter?   yes      no

Dues alone are not enough to support our many activities, environmental and education efforts.
Please consider a contribution in addition to your
$20 membership. Your additional contribution may
be tax deductible as RVAS is a 501 (C) 3 organization.

Friend of RVAS — Up to $25
Donor — $50          
Sponsor — $250
Supporter — $100   
Benefactor — $500            
Other $ ________

Please check here if you wish your contribution to be anonymous.

Mail this form with your check for
$20 RVAS dues and any contribution you wish to make, to:

Rogue Valley Audubon Society
P.O. Box 8597
Medford, OR 97501
Rogue Valley Audubon Society
PO Box 8597
Medford, OR 97501