Membership Form

Your name:

Address:

City, state, zip:

Email:

Telephone numbers:

   

Please circle and fill in.

Individual        $20+

Family             $40+

Corporate       $150+

Super              $500+

Full Bin Sponsorship     $1,200

Earth Guardian              $5,000+

Additional Contribution $ _______

Education $ ___________

 

The Park City Conservation Association, dba Recycle Utah, is a 501 c(3) non profit organization, making your donation tax deductible.

 

Method of Payment:

Check or Credit card for donations over $59.00 or a $5 service charge for donations under $59.00

 

 

Name on card:
CC Number:
Exp date:	Tel. #
Billing zip code:	Amount:
Signature:

 

1951 Woodbine Way,  P.O. Box 682998, Park City, UT 84068 
(435) 649-9698 - (fax) 658-1530