MEMBERSHIP FORMS Please print and mail to: Chula Vista Nature Center, 1000 Gunpowder Pt. Dr., Chula Vista, CA 91910, or Fax (619) 409-5910.

PLEASE CHECK ONE: NEW MEMBERSHIP MEMBERSHIP RENEWAL

Please check membership category:
MEMBER SENIOR/STUDENT MEMBER PLUS

Please PRINT first and last names of adult(s):

_____________________________________________________________________
Mr./Mrs./Ms. (please circle one)

_____________________________________________________________________
Mr./Mrs./Ms. (please circle one)

_____________________________________________________________________
Mailing Address

_____________________________________________________________________
City, State & Zip

(_____)____________________________(______)___________________________
Day and Evening phone

_____________________________________________________________________
E-mail address

For MEMBER PLUS applicants:
Do you have children or grandchildren between the ages of 3 and 18 that you'd like to include on your MEMBER PLUS membership? Please list their complete names and birth dates:
Name(s):                                                                                                        Birth date(s):

                                                                                                                      (mm/dd/yy)
__________________________________________________________ ___/___/___

__________________________________________________________ ___/___/___

__________________________________________________________ ___/___/___

Memberships make great gifts!
If this membership is a gift for someone else (listed above), please enter your name and address below:

__________________________________________________________________
Name
__________________________________________________________________
Address
_______________________________________(_____)_____________________
City/State/Zip                                                         Phone

 

PAYMENT INFORMATION

Please make checks payable to Chula Vista Nature Center and return to:

Chula Vista Nature Center
1000 Gunpowder Point Drive
Chula Vista, CA 91910-1201

-Or-
Charge my Visa/MasterCard $________________________
                                                          (total amount)
Acct.#______________________________________Exp.Date ____________

Cardholder name: (please print) _____________________________________

_______________________________________________________________
Cardholder signature

Thank You!