Individual Membership
Application for Individual Membership in the Vivian G. Harsh Society
All Vivian G. Harsh Society membership levels include a subscription to our quarterly newsletter, program and event announcements as well as additional benefits at higher levels of support. Please complete the form below and join today.
Fields marked * must be completed for the form to be submitted. After you submit your application you will have an opportunity to pay via a PayPal link. You will not need to have a PayPal account to process your payment. Instructions for payment by check will also be available.
- Name *TitleFirstLastSuffixPlease give us your Name as you would like it to appear.
- Email *For VGHS communications only. Your address will not be shared. You may opt out at any time.
If you don't have an email address, please include none@none.com in the field. - Address *Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountryWe will send your newsletter and other VGHS communications to this address. (One address per membership.)
- Phone *(###)-###-####
- Please indicate your participating level of membership for individuals: *$50 - Basic$100 - Supporter$25 - Seniors (60+)$20 - Students$250 - Friend$500 - Sustainer$1,000 - Patron$2,500 - Contributors CirclePlease choose your level of membership in the Vivian G. Harsh Society, Inc.
- Preferred method of contact: *EmailPostNo preferenceContact information is solely collected for the use of the Vivian G. Harsh Society. You may opt out of our communications stream at any time.