Membership Information:
Join the Friends of the Conservancy

To become a Friend of the Independence Conservancy, please complete the form below, print it, and mail with your check or money order to: Independence Conservancy, Inc. P.O. Box 248 Industry, PA 15052-0248 (For best print results, use landscape orientation and print only page 2.) Your information is kept strictly private. Independence Conservancy does not sell or share anyone's contact information.

Winter at Raccoon Creek.

Membership Form

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Name:
Address:
City:
State:
Zip Code:
Phone:
E-mail:
Please check the category you prefer:
	Benefactor $1,000
	Business/Corporate Sponsorship $500
	Patron $100
	Family $35
	Individual $25
	School .50 per capita for School District, Building, or Classroom
	I do not wish to become a Friend of the Conservancy at this time, but please accept my donation.

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Contributions to the Independence Conservancy are
deductible for federal income tax purposes.

Registration information is available from the
PA Dept. of State, Corporations Bureau at 1-800-732-0999.

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