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Gift Membership Form
Friends of Bellingrath Gift Membership Form
Please send a Friends of Bellingrath Gift Membership to:
Name: ________________________________________________________________
Address: _____________________________________________________________
City: ___________________________ State: _______________ Zip: ____________
Telephone Number: _______________________ Email: _______________________
From:
Name: _______________________________________________________________
Address: ______________________________________________________________
City: _________________________ State: _________________ Zip: _____________
Telephone Number: _______________________ Email: _______________________
Is this gift for a special occasion? ¨Yes ¨ No
If yes, please specify occasion: _______________________________________________________________
Please tell us what special remarks you would like on the gift card.
_________________________________________________________________________________________
Send Renewal Notice to: ¨ Me/Us ¨ Recipient
Gift Membership Level:
¨ Individual $50 ¨ Couple $75 ¨ Family $100
Patron Levels:
¨ Rose $150 ¨ Azalea $250
Belle Camp Society Levels:
¨ Silver $500 ¨ Gold $1,000 ¨ Platinum $2,500
Total Amount Enclosed $______________________
¨ Check Enclosed (Payable to Bellingrath Gardens and Home)
¨ Visa ¨ MasterCard ¨ Discover ¨ American Express
Credit Card Number: ___________________________________Exp. Date: __________
Signature: __________________________________________________________________
Form may be printed and mailed with payment to:
Membership Office
12401 Bellingrath Gardens Road, Theodore, AL 36582
251-973-2217 ext. 165 Fax 251-973-0540
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