SCCi Membership Application

Print this form using your web browser, then fill in the information below. You may pay by check, money order, or credit card. Mail the completed form to:

Southeastern Cave Conservancy
PO Box 71857
Chattanooga TN 37407-0857

YES! I would like to join the Southeastern Cave Conservancy and help buy, manage, and protect caves. 

Please provide your contact information:
Name _________________________________________________
Street  _________________________________________________
City _________________________________________________
State _________________________________________________
Zip Code _________________________________________________
Telephone  _________________________________________________
EMail  _________________________________________________
 

Chose either Regular or Sustaining Membership:

 

Regular Membership

Annual Dues ___ $15

Additional Donation $ _______

 Regular membership is $15 per year. Dues expire on September 30 of each year. Please enclose a check or money order payable to Southeastern Cave Conservancy, or charge you dues using the credit card section below
 
Sustaining Membership - monthly or quarterly contribution via debit or credit card
Please choose a Monthly or Quarterly contribution amount:

Monthly
Amount:

___ $25

___ $20

___ $15

___ $10

Other 
$ _______

Quarterly
Amount

___ $100

___ $75

___ $50

___ $25

Other  
$ _______

Please specify the duration and starting date for your contributions:


Duration:


______
Until Canceled


______ 
Twelve  Months


______
Six Months


___________ Other 

Month to Begin:

_____________________, __________

,  , ,  

Please fill in your credit card information: Be sure to write your name exactly as imprinted on the card and to provide your phone number above in case we need to contact you to resolve any problems.

Card Type:


____Visa


___MasterCard


___AmEx


___ Discover

Card Number:

___________________________________________________ 

Name on Card

__________________________________  (as imprinted on card)
Expiration Date: __________________________________  (as imprinted on card)
Sustaining memberships totaling $120 or more per year and one-time donations of $250 or more are recognized with an SCCI logo shirt. Please specify your desired shirt size:
Shirt Size: _____________________

To pay by credit card, please sign and date this form as indicated below:

I hereby authorize the Southeastern Cave Conservancy, Inc. to charge my account in the amount and for the duration indicated above. I understand that I may terminate my sustaining membership at any time by contacting the SCCi.

Signature: ________________________________________ Date: _________________

Your donations are tax deductible in accordance with IRS rules for charitable contributions. The SCCI is a 501(c)3 tax-exempt non-profit organization, and donations are normally fully deductible. Each check or charge on a credit or debit card is treated by the IRS as a separate donation. This form and your cancelled checks or credit card statements serve as proof of your donations. Donations of $250 or more will be acknowledged with a letter for your files by January 31 of the year following the date of the donation.