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Friends Of The Clearing

Friends Membership Application

Please print out this form, fill it out and mail it to

The Clearing, P.O. Box 65, Ellison Bay, WI 54210.

Name(s):	_____________________________
Street:	_____________________________
City:	_____________________________
State:	_____________________________
Zip Code:	_____________________________
Phone:	_____________________________
	Membership Categories:
	____Individual - $35 per year
	____Couple - $70 per year
	____Business - $75 per year
	____Individual Life - $350
	____Couple Life - $650
Payment Method:
	____Check
	____Mastercard/Visa
Card Number:	_____________________________
Expiration Date:	_____________________________
Signature:	_____________________________

Please make your check payable to The Clearing.

The Clearing is a non-profit corporation under Section 501(c)(3) of the Internal Revenue Code. Membership dues and other contributions to The Clearing are tax-deductible.