To become a Virginia Eastern Shorekeeper Associate, please complete and return this form:

R Yes, I want to be a Virginia Eastern Shorekeeper Associate

Name: _______________________________Phone: _______________________

Address: ___________________________________________________________

City: ____________________ State: ____________ Zip: ______________

Email address: __________________________________

Enclosed is a tax-deductible contribution of: o $10.00 associate, or o $ _______
o Please provide a receipt for tax purposes

o I am interested in becoming a Volunteer Creek Watcher

o I am interested in volunteering. My interests are:

______________________________________________________________________

Mail to: Virginia Eastern Shorekeeper, P.O. Box 961, Eastville, Virginia 23347-0961