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Name:____________________________________

Address:__________________________________

City:_____________________________________

State, Zip:_________________________________

E-Mail:___________________________________

Please choose a category:

a_____Sustaining:  $100   ($85 of this may be reported
as a charitable donation on your income tax)

b_____Contributing:  $50   ($35 of this may be reported
as a charitable donation on your income tax)

c_____Family:  $20

d_____Individual:  $15

We are only accepting checks at the moment. Please mail the appropriate
amount to the address below.

Rockingham Bird Club, Inc.
7738 Sparkling Springs Road
Singers Glen, VA 22850.