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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
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Family, Patron & Belle Camp memberships may include up to 2 adults
and 5 children in one household.)
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
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