Sandy Lick Conservation Initiative
Membership Application

Name________________________________________
Address________________________________________
City________________________________________
State________________________________________Zip Code__________
Phone(_____)__________________________________
Email________________________________________


Please circle which membership you would
like to have:

Individual$5.00
Family$7.00
Business$50.00


If you have any questions, please call or email:

Linda Makufka, Secretary
(814)375-9847
slci@hotmail.com

Please print the application and after completing it, mail to:

Sandy Lick Conservation Initiative
PO Box 93
DuBois, PA 15801