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SHOALS ENVIRONMENTAL ALLIANCE, INC.
Rogersville Area Special Interest Group
P.O. Box 509
Rogersville, AL 35630

MEMBERSHIP REGISTRATION

NAME: ________________________________________________________________

ADDRESS: _____________________________________________________________

______________________________________________________________________

PHONE NUMBERS: _______________________________________________________

E-MAIL: ______________________________________________________________

SPECIAL SKILLS OR INTERESTS:_ Rogersville area Elk River Marina _____

______________________________________________________________________

MEMBERSHIP FEES
(All fees & donations are tax deductible.)

BASIC INDIVIDUAL MEMBERSHIP

Member: $10.00 Student:$5.00

PATRON MEMBERS

(You can help us reach our goals and realize achievements sooner if you decide to
support at a higher level. Your contribution includes basic membership.)

Supporter $25. Patron: $50. Benefactor: $100. Angel: $250. Underwriter: $500. & above

PAYMENT

Check $___________

Cash  $___________