FRIENDS OF BELLINGRATH GIFT MEMBERSHIP FORM
Please send a Friends of Bellingrath Gift  Membership to:
Name: ________________________________________________________________
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:                       
General Membership Levels:   ¨  Individual $40  ¨  Couple  $60   ¨ 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