Fort Nathan Hale Membership Application and/or Donation Form

Name: ________________________________________________

Address1: ______________________________________________

Address2: ______________________________________________

City: __________________________ State: ______ Zip: _________

Telephone Day: _________________________________________

Telephone Evening: ______________________________________

email address: _______________________

Membership New or Renewal? ____________________

Please check your contribution category:

$15 Lieutenant $20 Captain $25 Major $50 Colonel $100 General

I enclosed payment of $ ________ for the category indicated above, payable to: FNHRP Inc.

I would like to contribute $ ___________ to the Annual Fund in addition to my membership fee.

Does you company match employee gifts? yes _____ no _____

Contributions are tax deductible within the limits permitted by law.

Mail to: Membership, FNHRP, P.O. Box 1981, New Haven, CT 06521