Landmark Park Membership Form

Yes, I want to Join Landmark Park and help preserve our cultural and natural heritage!

Print this page and fill in the information blanks, then send completed form and payment to:

Landmark Park
PO Box 6362
Dothan, AL 36302

___ New Membership ___ Renewal Name ______________________________________________ Address ____________________________________________ City _______________________ State ______ Zip ________ Phone (___)________ Cell (___)________ Work(___)________ E-Mail _______________________________________________	Membership Categories Annual ___ Individual ($25) ___ Family ($50) ___ Seniors Couple ($35) (65 or older) ___ Historical ($75) ___ Heritage ($125) ___ Heirloom ($250) ___ Legacy ($500) ___ President's Circle ($1000)

Make check payable to Landmark Park
or
Please charge my account below:

___ Visa ___ Mastercard

Card Number _________________________________________

Expiration _____ Signature ______________________________