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Membership Application Form
Please print this page, fill in the information and send with payment

Primary Contact Name:
Title:
Company/Organization:
Address:
City/State/Zip:
Phone/Fax:
e-mail:

Alternate Contact Name:
Title:
Company/Organization:
Address:
City/State/Zip:
Phone/Fax:
e-mail:

Membership Level: (please check one)

bullet $50  Individual Citizen
bullet $95  Individual Business Professional
bullet $295  Small Business (fewer than 10 employees) or Non-Profit Organization
bullet $495  Corporate
bullet $1500  Corporate Plus
bullet $3,500  Sponsor
bullet $8,000  Benefactor

WEI is a non-profit 501c(3) corporation, making your contribution tax deductible.
Please make check payable to Wisconsin Environmental Initiative.
Return completed form with membership fee to:

Wisconsin Environmental Initiative
16 N. Carroll St., Suite 840
Madison, WI 53703

Thank you very much for joining Wisconsin Environmental Initiative.

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