the 2015 Membership Form

Please Support Quogue Wildlife Refuge
BECOME A MEMBER TODAY
Membership & Renewal
YES! I WANT TO SUPPORT THE QUOGUE WILDLIFE REFUGE WITH A TAX-DEDUCTIBLE DONATION.
❑ Individual - $35 ❑ Family - $50 ❑ Sponsor - $100 ❑ Guardian - $1,000 ❑ Underwriter - $2,500 ❑ Benefactor - $5,000
❑ Protector - $250 ❑ Patron - $500 ❑ Humanitarian - $10,000 ❑ Other______
With a donation of $35 or more, you become a member of Quogue Wildlife Refuge for the calendar year.
M E M B E R B E N E F I T S A N D P R I V I L EG ES I N C LU D E:
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Our quarterly newsletter mailed to you with upcoming events and interesting wildlife articles
Free and discounted admissions to various programs, including priority sign up for our Summer Ecology Program
Free use of snowshoes and cross country skis to use on our seven miles of trails
10% Discount on Gift Shop Purchases + Green Birthday Programs for Children
A Quogue Wildlife Refuge Decal
Invitation to our members only BBQ in June
A great feeling knowing that you support the Quogue Wildlife Refuge where preservation and education are a priority
Member donations help maintain the Refuge, protect wildlife, and support our many educational programs.
Please make checks payable to: Quogue Wildlife Refuge. Please charge ❑ AMEX ❑ VISA ❑ MC ❑ Discover
Mail to QUOGUE WILDLIFE REFUGE PO Box 492, Quogue, NY 11959
Card #____________________________________________________________________________ Exp. Date__________________
Name ________________________________________________________ Signature______________________________________
Address______________________________________________________________________________________________________
Billing Address (if different from mailing address)_____________________________________________________________________
City_______________________________________________________________ State__________________ Zip________________
Telephone _____________________________________ Email__________________________________________________________
PLEASE CHECK BELOW FOR MORE INFORMATION ON ESTATE PLANNING AND/OR GIFTS OF APPRECIATED STOCK OR LIFE INSURANCE.
❑ I have included Quogue Wildlife Refuge in my Will.
❑ Please contact me with information of how to include Quogue Wildlife Refuge in my Will.
❑ Please contact me with information on making gifts of appreciated stock or life insurance.
Double your support and include Quogue Wildlife Refuge in your company’s Matching Gift Program!
Quogue Wildlife Refuge is a nonprofit 501(c)(3) organization and is registered with the
New York State Office of Charities Registration as Southampton Township Wildfowl Association, Inc. TAX ID # 23-7108469.
(631) 653-4771, www.QuogueWildlifeRefuge.org, info@quoguewildliferefuge.org
Thank You!