Membership Form

 

Primary Name

Secondary Name

_____________________________________

_____________________________________

Are you a community or school gardener? Name of Garden:

________________________________________
Address ________________________________________
City, State, Zip ________________________________________
E-mail ________________________________________
Daytime Tel ________________________________________

Check one:
New Member
Renewing Member
Additional Donation - I'm already a member

Donation Amount:
$20 community gardener, student or senior
$30 individual
$40 family, school or organization
Name:______________________________________________
$100 supporter
$300 sponsor
$500 sustainer
Other amount ______________________________________

Method of Payment:
Check (payable to Urban Harvest)
Master Card       Visa

Credit Card #_________________________Expiration Date__________
3-digit number on the back of your card_______

 

Urban Harvest
2311 Canal St., Suite 200
Houston, TX 77098-0460

Thank you for your generous contribution.
New members will receive a welcome packet of information.
Contributions are tax-deductible as allowable by law.