Historic Macon Foundation
New Member/Renewal Information Please provide our office with the following information so that we can process your membership correctly. NAME:_________________________________________________________________ ADDRESS:______________________________________________________________ ________________________________________________________________________ EMAIL:_________________________________________________________________ PHONE NUMBER:(home)_______________________ (work) ____________________ PREFERRED METHOD OF CONTACT ____ Email ____ U.S. Mail MEMBERSHIP LEVELS ___ $20 Student ___ $50 Individual ___ $75 Family ___ $150 Patron ___ $250 Benefactor ___ $500 Sustaining ___ $1000 Historic Macon Club METHOD OF PAYMENT ___Check Enclosed Credit Card __Visa __MasterCard____ Credit Card # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp_________ MONTHLY CONTRIBUTION: I am joining or renewing at the Patron level or above and would like to my contribution by credit card in monthly installments. I authorize Historic Macon Foundation to charge my credit card monthly until further notice. _________________________________________ Signature
MATCHING GIFT: My employer will match my contribution. Yes____ No____ Don’t know_____ (We will call you for more information.)
Send form to: Historic Macon Foundation, Inc., P.O. Box 13358, Macon GA 31208. Please call 742-5084 if you have questions.
Don’t forget, Historic Macon Foundation Memberships make great gifts. Thank You!