To join PA CleanWays
in the fight against illegal dumping and littering, return
this form and your dues to the address below. If a chapter
or affiliate exists in your area, your membership dollars
will help support those efforts
PA CleanWays
105 West Fourth Street
Greensburg, PA 1560
CONTACT / BILLING
INFORMATION
Name: ___________________________________
(If using credit or debit card, name and address
must
be exactly as they appear on your credit card statement.)
Senior - $10
Family $20
Small Business - $50
Donation of $____
PAYMENT METHOD
(select one):
Enclosed is my check for $_______ payable to "PA CleanWays"
Please charge my credit card for $_______
Credit card #: __________________________________
Card Type (check one):
Visa (or)
Mastercard
Expiration Date: ______________
Cardholder Signature: ____________________________
Return this
form and your membership contribution to:
PA CleanWays
105 West Fourth Street
Greensburg, PA 15601
Thank
you for your support!
A copy of PA
CleanWays' registration and financial information may be
obtained from the PA Department of State. Donations to PA CleanWays
are
tax-deductible.
PA CleanWays
does not sell, share, or otherwise distribute contact
information from its contributors. The information you provide
above will be
used for the purpose of accepting and processing your donation
and for
sending periodic mailings about our work and programs.
Check this box if you do not wish to receive mail from us.
