Opacum Land Trust Paws Membership Form

Opacum Land Trust Paws Membership

This Paws Membership is for::

Dog 's Name:_____________________________________________

Address:____________________________________________

_____________________________________________

City, State, Zip:________________________________________

E-mail:______________________________________________

Phone:______________________________________________

And:

Human's Name:_____________________________________________

If different from above:

Address:____________________________________________

_____________________________________________

City, State, Zip:________________________________________

E-mail:______________________________________________

Phone:______________________________________________

We would like to make an additional contribution of $________

to be used for:__________________________

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

Please make checks payable to Opacum Land Trust, and send it with this Paws membership form to:

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

Thank You For Your Support!