FRIENDS OF FORT KNOX

MEMBERSHIP/DONATION FORM


To Join the Friends of Fort Knox, print out the form below and mail or fax to:  
                
 Friends of Fort Knox
                   
 PO Box 456
               
 Bucksport, ME 04416-0456
                   
 Fax  (207) 469 – 6906

First Name: __________________________________________________

Last Name:  __________________________________________________

Company:  ___________________________________________________

Address:     ___________________________________________________

City:           ____________________________________________________

State:          ____________________________________________________

Zip/Postal Code: ______________________________________________

Country:    ____________________________________________________

Phone # :   ___________________________________________________

Fax # :        ___________________________________________________

Email Address: ________________________________________________


Membership Levels:                                                 Donation Levels:
__ new    __renewal                                       Maine Infantry Soldier $25-$99            

__ $10 Senior/Junior Membership             Sergeant Heygi Club   $100-$249

__ $20 Individual                                           Mount Waldo Granite $250-$499                         

__ $35 Family                                                Rodman Cannon Society $500-$999

__ $100 Supporter                                        General Henry Knox Council $1000 or more

__ $500 Benefactor

Amount Enclosed for __ Membership and/or __ Donation (check all that apply):

Membership     $_____________

Donation          $_____________

Total enclosed  $_____________

METHOD OF PAYMENT    __ Check (Payable to Friends of Fort Knox)

__ Credit Card         __ Visa      __Mastercard   __Discover   

Card Number ___________________________________  Expiration Date (mm/yy) ___________

CVV Number_________

Cardholder (Please Print) ___________________________________________

Signature ________________________________________________________

(an IRS 501(c)(3) tax exempt organization)