Membership Form

Membership Form

Memberships & donations are a great way to support the

educational programming at D Acres of New Hampshire.

Please consider purchasing a membership for yourself and/or a young person

that might benefit from the programs that we offer.

Print this form, fill it out and return it with payment to:

D Acres of New Hampshire; P.O. Box 98; Rumney, NH 03266

Name(s): __________________________________________

Address: ______________________________________________

City, State, Zip: _______________________________________

Phone: (_____) _____-_________

E-mail: ________________________________

_____ Family ($35)

_____ Individual ($25)

_____ Low Income, Senior, or Student ($15)

$ ________ Additional Donation to support D Acres' educational programs

Total Amount Enclosed: $ __________

THANK YOU FOR YOUR SUPPORT!