Print this form and mail it to  H.A.T. P.O. Box 655 Colchester, Vt.  05446

Name:______________________________________________________________ Date:________________

Mailing Address: ____________________________________________________

City / State :_________________________________________________________

Zip code:_________________________

Telephone: (_____)_________________

E-mail address:_______________________________________ Profession :__________________________

Do you have a skill that may be useful to HAT? ______________________________________________________

(Please check one of the Annual Memberships listed below. Make checks payable to HAT)

_____ Individual- $20        _____ Couple - $30     _____ Family- $35

_____ Camp Sponsor- $100       _____ Business Sponsor - $100 to $500

_____ Corporate Sponsor - Over $500       _____ Donation

Amount of payment enclosed:__________________

I PLEDGE TO ADVANCE THE MISSION OF HAT.

Signature:_______________________________

 

 

Credit Card Payments:

Please charge the membership amount to my:

_____ Visa _____ Mastercard

Credit card number:________________________________________________

Expiration date (mm/yy):____________________________________________

Amount to be charged:___________

Signature as shown on the card:_______________________________________

 

Mail to:

HAT
P.O. Box 655
Colchester, Vt.  05446