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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
Card Number ___________________________________ Expiration Date (mm/yy) ___________
Cardholder (Please Print) ___________________________________________
Signature ________________________________________________________
(an IRS 501(c)(3) tax exempt organization)