2020 Membership Form

BECOME A MEMBER

make an investment today

to protect and care for environmentally significant land and water in Waukesha County for future generations.

As a member of the Waukesha County Land Conservancy, you are helping to ensure that Waukesha County’s most irreplaceable natural areas are protected today and for generations to come.

Name *

First Name Last Name

Is this a Family Membership ($100/year)? *

Yes No

List Family Member First and Last Names Included on Membership (up to four total):

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Membership *

Student $ 25.00

must provide current student identification card below

Individual $ 50.00

Family $ 100.00

for up to four people

Steward $ 250.00

Conservation Hero $ 500.00

Benefactor $ 1,000.00

Visionary $ 2,500.00

Legacy $ 5,000.00

Additional Donation $ 10.00

$10 increments

Quantity

Total $ 0.00

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Student Membership ID Card Upload:

Browse Files

Is this a Gift Membership?

Yes No

Gift Recipient Name

First Name Last Name

Gift Recipient Email

example@example.com

Gift Recipient Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Message to Include from Sender to Recipient:

*Environmentally Friendly Option: Check this box if you would like to receive membership materials electronically.

Yes! Save paper and send my membership card electronically via email.