Membership Form for New Members or Renewals

Yes! I(we) support the objectives of the San Vito Bird Club and would like to join or renew
my(our) membership(s) for 2014:
___ Resident* Member(s) @ US$20.00 or 10,000 per person for total of _____________.
___ International Member(s) @ US$15.00 or 7,500 per person for total of ____________.
* A Resident is someone whose primary residence is in Costa Rica.

Enclosed is cash or a check made out to San Vito Bird Club for the total above.
Name(s): ________________________________________________________
________________________________________________________
Address: ________________________________________________________
City: ____________________________________________________________
State/Prov: _______________________________________________________
Country: _________________________________________________________
ZIP/Postal Code: __________________________________________________
Email address(es): _________________________________________________
_________________________________________________
Phone/Fax: _______________________________________________________

Date: _______________

Mail form and check (please do not mail cash) to:

San Vito Bird Club
Attention: Alison Olivieri
Apdo. 17-8257
Puntarenas, Coto Brus, San Vito
60801 COSTA RICA
For cash payments, please contact Alison Olivieri at sanvitobirdclub@gmail.com.
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