Douthat S.P.E.ED. Membership Application

Douthat S.P.E.ED. Group
Douthat State Park Environmental Education Group
Douthat State Park * Route 1, Box 212 * Millboro, VA 24460
Phone: (540) 862-8100 * Fax: (540) 862-8104
Email: douthatspeed@yahoo.com
Website: www.douthatspeed.org

Name:_____________________________________________________________________

Organization or Business:_________________________________________________

Mailing Address:__________________________________________________________

Home Phone:________________________ Work Phone:___________________________

Email Address:____________________________________________________________

Signature:________________________________________________________________

Individual - $10 a year per active member.

Family - $25 a year for up to 4 parents and children. $5 a year for each additional active member.

Business - $8 a year per active member.

Club - $8 a year per active member.

Organization - $8 a year per active member.
What are your interests?
Membership
Finance
Audit
Car Show
Publicity
 Cultural Events
Beach Events
Benefit Auction
Website
Other
Stewardship and Evironmental Education Events


*S.P.E.ED. Use Only*
Date Membership Application Received and Dues Paid:____________________