Membership Form

Print this page and return completed form with check to:

672 11th Street, Oakland, CA 94607-3651

Please make checks payable to the Pardee Home Foundation.

Thank you for your support!

Name:__________________________________________________________


Address:_______________________________________________________


City:_______________________________ State: _____ ZIP: ________


Telephone: (   )     -       Email:____________________________

[ ] $15 Student	[ ] $25 Individual	[ ] $40 Family
[ ] $75 Institutional	[ ] $75 Benefactor	[ ] $100-249 Patron
[ ] $250-499 Sustaining	[ ] $500-999 Sponsor	[ ] $1000 and up Visionary

Amount enclosed:_________________ _____ My check is enclosed (Payable to the Pardee Home Foundation) _____ Please charge my _____ Visa _____ MasterCard _____________________________________________ Account Number Expiration Date _____________________________________________ Signature