This gift is for:

Recipient's Name:_____________________________________________
Address:____________________________________________
_____________________________________________
City, State, Zip:________________________________________
E-mail:______________________________________________
Phone:______________________________________________

I would like to give:

  ___An Individual Membership...$25.00
  ___A Family Membership...$40.00
  ___A Jr./Senior Membership...$20.00
  ___A PAWS Membership for a special pet...$30.00
  ___A Membership for my favorite business...$60.00

I am including an additional donation of : $_______

As a gift is from:

Your Name:_____________________________________________
Address:____________________________________________
_____________________________________________
City, State, Zip:________________________________________
E-mail:______________________________________________
Phone:______________________________________________

Total Amount Enclosed: ______________

Thank You For Your Gift! Please make checks payable to Opacum Land Trust, and send it with the gift membership form to:

Opacum Land Trust
Attention Membership
P.O. Box 233
Sturbridge, MA 01566

OLT is a 501(c)(3) non-profit organization, all contributions are tax deductible.