HelpNet Membership Form

___ An Individual member.
___ An Organizational member.
Name (of person or organization): ______________________________________
Contact person (for organizational member): _____________________________
Mailing address: ___________________________________________________
______________________________________________________________
Telephone: _____________________
Fax: _________________________
E-Mail: ____________________________
Web site (if applicable): ____________________________________
____ My/Our membership dues are enclosed. (Dues amounts: $5/year for individuals, $25/year for organizations with annual budgets of less than $50,000, $50/year for organizations with annual budgets of $50,000 or more. Please make check payable to Pine Tree Folk School, and indicate that it is for HelpNet membership.)
_____ I would like to make alternative dues arangements. (Dues obligations may be met by providing services in lieu of cash payment. We are all in this together, and no one will be denied membership because of inability to pay.)
Pleae print out this form, fill it out, and send it, with the appropriate dues payment, to:
HelpNet, c/o Pine Tree Folk School
RR 2, Box 7162
Carmel, ME 04419
207/848-2433


HelpNet is a project of Pine Tree Folk School, and is co-sponsored by Bairnet (the Bangor Area Information Resources Network) and by the Peace and Justice Center of Eastern Maine.