Assateague Coastal Trust P.O. Box 731 Berlin, MD 21811 Phone 410-629-1538
Print and mail this form to join ACT.

Yes, I want to join ACT!

____$30 Introductory (first time individual membership)
____$15 Student ____$35 Individual
____$50 Family ____$50 Non-Profit Organization
____$100 Steward ____$250 Guardian
____$300 Corporate ____$1000 Lifetime
____$______additional contribution

Please make your check payable to "Assateague Coastal Trust"
and mail it to the address above or fax it to: 410-629-1059

Name:______________________________________________________
Organization/Title:_____________________________________________
Address:____________________________________________________
City:___________________________ State:________ Zip:____________
Phone (work):_____________________ (home):____________________
Fax:_______________________________________________________
E-mail:_____________________________________________________

Yes, I would also like to become an active volunteer!

Please list your volunteer interests: (Advocacy, Education, Development,Administration, etc.)

_____________________________________________________

_____________________________________________________

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