Please print this page and mail with your membership fees to:

Maine Chapter of IAT/SIA
27 Flying Point Road
Freeport, Maine 04032

Cut at line below:

HELP US MAKE HISTORY... JOIN US

I/WE WANT TO JOIN THE MAINE CHAPTER OF THE IAT/SIA AT THE MEMBERSHIP LEVEL INDICATED.

Trail Blazer -$250______

Backpacker -$100______

Camper -$50______

Day Hiker -$35______

Naturalist -$15_______

Other outdoor enthusiast $_______

(Form generated via IAT Website)

Name__________________________________________

Address 1_______________________________________

Address line 2____________________________________

City, State and Zip Code___________________________________________

Phone #____________________Fax#___________________________

e-mail address____________________________________________

Please make your charitable contribution payable to:

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