Desert Tortoise Council
Membership Application

Please type or print

	NEW_____ RENEWAL______ CHANGE OF ADDRESS _______
DATE:	_______________________________________________________
NAME:	_______________________________________________________
PHONE:	_______________________________________________________
ADDRESS:	_______________________________________________________
CITY:	_______________________________________________________
STATE:	_______________________________ , ZIP: __________________
COUNTRY:	_______________________________________________________
EMAIL:	_______________________________________________________

To Pay By Check Print This Form and Mail to the Address Listed Below; to pay online through our secure server, click the button next to the appropriate membership level
*Membership Level*
	( __ ) Regular ($30.00 per year)
	( __ ) Organization ($125.00 per year)
	( __ ) Lifetime ($500.00 per year)
	( __ ) Student ($20.00 per year)
	(___) Donation
Student memberships require endorsement of student's Advisor or Major Professor.

*Please Check Preferred Delivery Method for Desert Tortoise Council Newsletter*
( __ ) pdf via e-mail
( __ ) E-mail notice for Webpage viewing
( __ ) Hard Copy Newsletter

Make checks or money order payable to the DESERT TORTOISE COUNCIL and send with the application to:

Desert Tortoise Council
P.O. Box 3273
Beaumont, CA 92223

The Desert Tortoise Council does not release its membership list

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