Operation Green Leaves
Membership Application
PO Box 5254, Coral Gables, Florida 33114

Please PRINT this form, provide the information and mail:

First Name	________________________________________________________________________
Last Name	________________________________________________________________________
Title	______________________
Organization	________________________________________________________________________
Street Address	________________________________________________________________________
Address (cont.)	________________________________________________________________________
City	________________________________________________________________________
State/Province	________________________________________________________________________
Zip/Postal Code	________________________________________________________________________
Country	________________________________________________________________________
Work Phone	________________________________________________________________________
FAX	________________________________________________________________________
E-mail	________________________________________________________________________
URL	________________________________________________________________________

Choose one of the following Membership options:

General ($25)  *  Supporting ($45)  *  Contributing ($100)  *   Student ($15)

Business ($250  *  Corporate ($500)  *  Trustee ($1000)

Can you donate a specific amount on a regular basis? If so, let us me know how much and whether it's monthly or quarterly. Thank you... nadine44@netscape.com

Copyright © 2009 [Operation Green Leaves]. All rights reserved.
Revised: 10/15/09