Yes! I’d like to give Xerces membership
Please print and fill out this form and mail with payment.
Choose one:
____ $35, one-year membership + Pollinator Conservation Handbook
____ $25, one-year membership only

ABOUT YOU
Your Name________________________________________

Address__________________________________________

City _____________________________________________

State _____ ZIP______________Country________________

Telephone (in case we have questions) ___________________
For credit card orders, also fill out the following:
Name on credit card & billing address, if different from above:

Credit card #:______________________________________

Expiration Date:___________________ VISA or MasterCard?_______

Your signature:_____________________________________________

ABOUT THE RECIPIENT
Recipient’s Name___________________________________

Address__________________________________________

City _____________________________________________

State _____ ZIP______________Country________________

We will send your recipient a copy of Wings plus a gift card. Message for card:

Please return this form with your check/money order or credit card information to:
Gift Membership, Xerces Society, 4828 SE Hawthorne Blvd., Portland, OR 97215 USA