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		Become A Member - Membership Form

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       The mission of the
   Prairie Preservation
   Organization is to
   preserve and to
   restore the natural
   habitat and to
   preserve, protect
   and restore native
   species worldwide.

Please fill out the membership form below and mail it in or Donate online.

Please print out the following form and send the form and donations to:

    The Prairie Preservation Organization
   201 1/2 East 8 th Street
   Junction City, Kansas   66441

You Name and Address All fields are required

Name:

Address Line:

Address Line 2:

City:

State:

Zip code:

Phone Number:

E-mail:

Donation Amount All amounts are in U.S. Dollars

   $25       $500
   $50       $1,000
   $100     $5,000
   $250     $10,000

Other Amount: $

Billing Information And Credit Card Information If you are sending a check or money order you do not need to fill this out

We take the following
credit cards: MasterCard Visa

Name On Card:

Card Number:

Expiration date:

     Authorization Signature:          __________________
     Sign after you have printed
       the form.

Bill Information    My credit card billing info is the same as my address above
   My credit card billing info is not the same as my address above please fill out the
          billing information form below. All fields are required.

Billing Address:

Billing Address line 2 :

City:

State:

Zip Code:


	Copyright © 2007 THE PRAIRIE PRESERVATION ORGANIZATION INC.