Please complete this form to join the Meriden Land Trust in its pursuit to maintain open space in Meriden.

Name:              ____________________________________________

Address:           ____________________________________________

____________________________________________

Telephone:_______________________

e-mail:_______________________

___ $15.00 per year, contributing member

___ $20.00 per year, supporting member

___ $25.00 per year, family

___ $50.00 per year, organizational membership

___ $1,000.00 lifetime member

The Meriden Land Trust is a 501(3)(c) nonprofit organization; membership dues are tax deductible.

I am interested in the following activities.  Please contact me:

___ Newsletter                                        ___Community Activities

___ Land Stewardship                          ___ Board of Director Position

___ Land Acquisition                            ___ Publicity

___ Membership                                  ___ Web site development

___ Fundraising                                    ___ Other _________________________________

For MLT use only:                                                                               Membership receipt month:

Thank you for your generous support!

Meriden Land Trust, P.O. Box 1745, Meriden, CT 06450-1745

meridenlandtrust.com