Membership form

Barrington Land Conservation Trust

Name
__________________________________________________
Life Member  
  $1000.00
Address
__________________________________________________
  Benefactor  
$ 500.00
City
__________________________________________________
Conservator 
$ 250.00
State __________ Zip Code _________ Patron  
  $100.00
Your gift is tax deductible. Sponsor
$ 50.00
Family/friend    
$  25.00
Sowams fund   
____________
Other  
________

Mail to: 

Barrington Land Conservation Trust 

P.O. Box 324

Barrington, RI 02806-0324