New York State Urban and Community Forestry Council New Membership Form

* denotes required fields.
* Member First Name:
* Member Last Name:
* Address:

* City, State, ZIP:	,
County:
Company / Affiliation:
Phone / Fax:	/
Web Address:
Email Address:
Sign-up Date:

Please select your tax-deductible Membership donation to the NYS Urban and Community Forestry Council in the following*:
	Student - $10.00 Individual - $20.00 Non-Profit Organization - $75.00 4 Designated members per membership Governmental Agency - $100.00 5 Designated members per membership Small Business - $120.00 (1-49 full time employees) 6 Designated members per membership Medium Business - $200.00 (50-99 full time employees) 10 designated members per membership Corporate - $500.00 (100 full time employees or more) 12 Designated members per membership

*Memberships run January-December and dues are not pro-rated.