To become a Member please print this page, fill out the form by hand,
enclose a check or money order, and mail to:
Wilderstein Historic Site
PO Box 383
Rhinebeck, NY 12572
Choose your desired category of support:
| Closest Companion | $2,500 + |
| Daisy's Tea Club | $1000 - $2499 |
| Tower | $500 - $999 |
| Friend of Fala | $150 - $499 |
| Dual/Family | $80 - $149 |
| Individual | $50 - $79 |
Name __________________________________________________________
Address ________________________________________________________
City/State ______________________________________ Zip _____________
Tel/Email _______________________________________________________
______ My company will match
this gift
(please include form).
______ Please contact me about contributing through a stock
transfer.
______ I would like my entire membership contribution to support Wilderstein and do not
wish to receive any non-deductible benefits.