LOTUSLAND MEMBERSHIP

Membership type:
 New     Renewal

Membership Level:
___Level I$75___Garden Patron $2500
___Level II$125 ___Garden Benefactor$5000
___Level III $500___Garden Sponsor $10,000 & above
___Level IV $1000

Name(s) to appear on membership card: (Please Circle) Mr / Mrs / Ms / Mr & Mrs / Miss / Dr

______________________________________________________________________________

______________________________________________________________________________

Address:______________________________________________________________________

City, State, Zip:_____________________________________________________________

Telephone:_________________________ Email: ___________________________________

Membership dues: $________
Gift membership(s): $________
Additional contribution: $________
*Total Amount Enclosed: $________   *Memberships are tax deductible

Payment options:
 Check enclosed payable to Ganna Walska Lotusland Foundation
Charge my    Visa     Mastercard    American Express

ACCT. No:___________________________________________        Exp:______________

Signature:_________________________________________________________________

[Charges cannot be processed without accurate expiration date]

Please allow 2 weeks to process membership- or call 805-969-3767 if special needs apply.

Mail or fax printed form to:
Ganna Walska Lotusland Foundation
Attn: Membership Department
695 Ashley Road
Santa Barbara, CA 93108-9939

Fax: (805)969-4423