ALCDC

Arkansas Land and Community Development Corporation

                    Sample Form (Please Go to Donation to Register Online)   

Date:

 

 

  

Participant/Agency Information

  First:

    

Middle:       Last"

 

 

 

 

 

 

Agency:

 

 

 

Street address:

 

City: State: ZIP: 

 

E-mail: 

 

 

     

 

 

 

 

 

  

 

   
 

     

     

     

     

    

Please mail this form to ALCDC, P.O. Box 743, Brinkley, AR 72021

                                                                               

PLEASE CHECK ONE: 

 

____ Farmer

 

____ Landowner

 

____ Community Resident

 

____ Organization Representative

 

 

 

 

 

 

 

Signature

 

Date

 
  ALCDC Membership

 

    ALCDC MEMBERSHIP

RENEWAL FORM

 

Oct. 2016-Sept. 2017

 

     _______ Individual Membership $25                                        

      _______ Organization membership $125

Yes, I want to support Arkansas Land and Community Development Corporation and its work to improve socioeconomic conditions for rural communities through land retention, family farms, youth, and community development. I have selected the best membership for me, and have enclosed my annual membership dues.

 

NAME: _________________________________________________________________

 

ADDRESS: _____________________________________________________________

 

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Email Address:________________________________________________

PHONE: ________________________________________________________________

 

Please return your application and dues to:

ALCDC Membership Program

P.O. Box 907

Brinkley, AR 72021

(Make checks payable to ALCDC Membership Program)

 

ALL CONTRIBUTIONS ARE TAX-DEDUCTIBLE.  THANK YOU FOR YOUR SUPPORT.

ALCDC programs and services are offered on a nondiscriminatory basis without regard to race,
color, national origin, religion, gender, or physical handicap.

 

 

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