Print this form and mail it to H.A.T. P.O. Box 655 Colchester, Vt. 05446
Name:______________________________________________________________
Date:________________
Mailing Address: ____________________________________________________
City / State :_________________________________________________________
Zip code:_________________________
Telephone: (_____)_________________
E-mail address:_______________________________________ Profession :__________________________
Do you have a skill that may be useful to HAT? ______________________________________________________
(Please check one of the Annual Memberships listed below. Make checks payable to HAT)
_____ Individual- $20 _____ Couple - $30 _____ Family- $35
_____ Camp Sponsor- $100 _____ Business Sponsor - $100 to $500
_____ Corporate Sponsor - Over $500 _____ Donation
Amount of payment enclosed:__________________
I PLEDGE TO ADVANCE THE MISSION OF HAT.
Signature:_______________________________
Credit Card Payments:
Please charge the membership amount to my:
_____ Visa _____ Mastercard
Credit card number:________________________________________________
Expiration date (mm/yy):____________________________________________
Amount to be charged:___________
Signature as shown on the card:_______________________________________
Mail to: