Please print and submit this form with your check payable to:

The Sippican Lands Trust
589 Mill Street, Marion, Massachusetts 02738

Name: ____________________________________________________ 

Winter Address: ____________________________________________

City, State, Zip: ____________________________________________

(Dates) ___________________Winter Telephone:_________________

Summer Address:___________________________________________

City, State, Zip:_____________________________________________

(Dates)___________________Summer Telepone:_________________

E-Mail: ________________________________________

Check one of the following boxes:

  $5,000+ (or land donation) Life Member
  $1,000 Osprey Society
  $500 Great Blue Heron
  $250 Red-Tailed Hawk
  $100 Roseate Tern
  $50 Flicker
  $25 Bluebird
  $15 Hummingbird (Seniors and Students)

  I would like to volunteer, please contact me.

The Sippican Lands Trust is a membership-supported, 501(c)(3) nonprofit organization. All contributions are tax deductible.