Membership Form

Please print this form and mail or fax to:
Cornell Plantations
One Plantations Road
Ithaca, NY 14850
Phone: 607-254-4727 Fax: 607-255-2404

MEMBER INFORMATION

This is a New Membership Membership Renewal

Membership Level
Student $25
Member $50
Household $75

Additional Gifts
Ivy Society ('93-'02) $250
Charter Society $500
Sponsor Club $1,000
Tower Club $5,000+

Name:

Address:

City:
State:
Zip:

Phone:
Email:

For Cornell Alumni
Cornell Class:
Spouse's Name:

Spouse's Class:

GIFT MEMBERSHIPS

Membership Level
Student $25
Member $50
Household $75

Additional Gifts
Ivy Society ('93-'02) $250
Charter Society $500
Sponsor Club $1,000
Tower Club $5,000+

Recipient's Name:

Recipient's Address:

City:
State: Zip:

Recipient's Phone:

PAYMENT INFORMATION

Membership Level Student $25 Member $50 Household $75 Additional Gifts Ivy Society $250 Charter Society $500 Sponsor Club $1,000 Tower Club $5,000+	New membership amount
	Membership renewal amount
	Gift membership amount

	Additional gift to Cornell Plantations

Total amount enclosed

Payment Method Check (Payable to Cornell Plantations) Credit Card Visa Mastercard American Express Credit Card #: Exp. Date: Month/Year

Please print this form and mail or fax to:
Cornell Plantations
One Plantations Road
Ithaca, NY 14850
Phone: 607-254-4727 Fax: 607-255-2404

Thank You!