Brunswick Environmental Action Team

(BEAT)

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   Membership Form (Individual, Family, Student, Gift)

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(Memberships are for the calendar year)

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A Suggested Membership Fee Scale is: $10 for an individual; $15 for family memberships and; $5 for a student membership; Gift memberships may be given for any appropriate membership category.

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NOTE: Those wanting to become members but able to pay only a

lesser amount are welcome to pay what they can

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 - )? Do you support these statements?

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   _____ Yes - then please do send in the form and we look forward to having you as a member

   _____  No - then we appreciate your desire for civic involvement, but BEAT does not seem to be a good fit for your interests

Name:

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Address:

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Phone:

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E-mail:

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Membership Type:

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Individual

Family

Student

     At what school?

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

___ Other (specify) _____________

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

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_____ Finance/Fund-raising

_____ Media

_____ Special Events

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