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Become a Member Today!
Friends of Bellingrath Membership Form
□ New Membership □ Renewal □ Gift
(Mr./Mrs./Ms.)__________________________________________ ______________________________ Date of Birth
(Mr./Mrs./Ms.)__________________________________________ _______________________________ Date of Birth
Address________________________________________________________________________________
City: __________________________________ State: _________________ Zip: ___________________
Telephone: ________________________________ Email: _____________________________________
Children's Names & Date of Birth
1. _______________________________________________________ DOB: ___________________
2. _______________________________________________________ DOB: ___________________
3. _______________________________________________________ DOB: ___________________
4. _______________________________________________________ DOB: ___________________
5. _______________________________________________________ DOB: ___________________
(Family, Patron & Belle Camp memberships may include up to 2 adults and 5 children under the age of 18 in one household.)
I am a Facebook Fan Bellingrath Gardens and Home. □ YES □ NO
Membership Levels
General Membership Levels: □ 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, Alabama 36582
Phone: 800.247.8420 / 251.973.2217 ext. 165
Fax 251.973.0540
4/2010 - 4
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