Ascutney Mountain Audubon Society
A Chapter of the National Audubon Society
PO Box 191
Springfield, VT 05156
Chapter Code X05

Please complete:

Name: ____________________________________________________


Town, State, Zip:_____________________________________________

Check all that apply:
I want to join Ascutney Mountain Audubon Society and the National Audubon Society at the introductory rate of $20.
I do not wish to receive AUDUBON magazine.
Do not share my name with any other organization.
I want to be a friend of Ascutney Mountain Audubon Society for $15.

Send this form and a check to: Ascutney Mountain Audubon Society, PO Box 191, Springfield, VT 05156