Gift Membership Form

Gift Membership Form
 
Friends of DISL Foundation Gift Membership Form
 
Please send a Friends of the Sea Lab Gift Membership to: 

Name: ________________________________________________________________

 
Address: ______________________________________________________
 
City: ___________________________  State: _______________ Zip: ____________
 
Telephone Number: _______________________ Email: _______________________
 
 
From:
Name: _______________________________________________________________
 
Address: ______________________________________________________________
 
City: _________________________ State: _________________ Zip: _____________
 
Telephone Number: _______________________ Email: _______________________
 
Is this gift for a special occasion?  __Yes   __No  
 
If yes, please specify occasion: _______________________________________________________________
 
Please tell us what special remarks you would like on the gift card. 
 
_________________________________________________________________________________________
 
Send Renewal Notice to:   __Me/Us                               __Recipient
 
Basic Levels: ___Student ($30) ___Individual($50) ___Family($100)
 
Advanced Levels:  ____Seahorse($250)  ______Skate ($500) ______ Starfish ($1000) _____School of Fish($2500)  
 
______/_____/_______ Today’s date

 
Total Amount Enclosed $______________________
__Check Enclosed (Payable to DISLF )
__Visa         __MasterCard      
 
Credit Card Number: ___________________________________Exp. Date: __________
 
Signature: __________________________________________________________________


Please download and print pdf Gift Form.   Mail to DISLF P.O. Box 82151 Mobile, Al  36689