Membership Form

Brunswick Environmental Action Team

(BEAT)

Membership Form (Individual, Family, Student, Gift)

Submit your BEAT membership form and you will be automatically added to the growing list of BEAT members. Membership is FREE!

To become a member of the Brunswick Environmental Action Team, please complete the form below and send a copy of your completed form to the BEAT president, Pete Key, at: beatpres@gmail.com

Before completing the membership application, be sure to read BEAT's mission statement, vision statement, and core values (available on our website - www.bcbeat.org)?

If you honestly support BEAT vision and mission statements as outlined on the description on our webpage please send in the form and we look forward to having you as a member

We look forward to finding local environmental issues that we can work on together.

Name:

Address:

Phone:

E-mail:

_____________________________________________________

Membership Type:

____

____ (please list all names above)

____

_________________

Individual

Family

Student

At what school(s)?

Have you received this membership as a gift? _____ Yes _____ No

Primary Areas

of Environmental

Interest (check

as many as apply):

___ Clean, renewable energy

___ Ecosystem/wildlife protection

___ Environmental Injustice

___ Land conservation/

management

___ Nuclear safety

___ Seismic blasting/offshore

drilling

___ Water quality/storm water runoff

___ Climate change/global warming

___ Dredging of waterways

___ Industrial agriculture/hog farming

___ Landfills/recycling/plastics

___ Pollution (air, marine, solid waste, water)

___ Terminal groins

___ Open burning of trash

___ Other (specify) _____________________

Please check any standing committees in which you might be interested in serving; check all that apply)

_____ Finance/Fund-raising

_____ Media

_____ Special Events

Please return your completed form to Pete Key, BEAT President, at: beatpres@gmail.com