Preservation Durham Membership Application Membership is for a calendar year. Preservation Durham is a 501(c)3 corporation. Membership and contributions are tax deductible as allowed by law. Name _____________________________________________________ Address ___________________________________________________ City ________________________State _______Zip ________________ Telephone (day)__________________(evening)____________________ Fax_________________ Email__________________________________ ___I (and/or my spouse) work for a matching-gift company ___Signed matching form enclosed ___Matching form will be filed
I am applying for the following membership option: ___George Watts Hill Leadership Circle $1000 ___Sustainer $500 ___Patron $250 ___Friend $100 ___Family $60 ___Individual $35	I would like to contribute to Preservation Durham ___Endangered Properties Fund       Amount_____________ ___George & Mary Pyne Endowment Fund       Amount_____________
___Enclosed is my check for $__________, payable to Preservation Durham ___Charge to ___MasterCard ___Visa Account #____________________________________Expiration date_________ Signature_____________________________ Please print this form, fill it in, and return by mail to: Preservation Durham, PO Box 25411, Durham NC 27702 or fax it with credit card payment only to (919)-489-4499. Thank you! November 2009