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Southern Springs Holistic Learning Center

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I want to contribute to the Southern Springs Land Acquisition Fund

PLEASE PRINT FORM, COMPLETE, AND RETURN WITH CHECK TO:
Southern Springs, 2032 Wedgewood Drive, Tallahassee, FL 32311

I would like to contribute to the Southern Springs Land Acquisition Fund
(Please mark amount and enclose contribution. Make checks payable to Southern Springs.)

___ $15

___ $25

___ $50

___ Other $________

I would like to become a Charter Member of Southern Springs
(Please mark amount and enclose contribution. Make checks payable to Southern Springs.)

___

$1,000

(Five-year membership with 15% discount* on all weekend workshops)

___

$5,000

(Five-year membership with 50% discount* on all weekend workshops)

___

$10,000

(Five-year membership with 100% discount* on all weekend workshops)

For Charter Members (Please check, as applicable):

___

I would like to have my name included on a plaque that will be displayed on the Southern Springs retreat campus.

___

I designate** the following person to receive Charter Membership benefits in my place:

Name____________________________________________________________________________

Address__________________________________________________________________________

City____________________________________ State_________ Zip_________________________

Phone - Home_____________________________ Work___________________________________

E-mail____________________________________________________________________________

* Discounts will not apply to weekend workshops that are limited by the workshop leader to 20 or fewer participants.

** Benefits are nontransferable once assigned. If no designation is indicated, the contributor will be assigned the benefits.

For more information call 850-878-8643

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Home Page \ Southern Springs, Inc. \ Holistic Learning Center \ Board of Directors \ Donations
Workshops and Events Calendar \ Registration Form \ Scholarship \ Presenters \ Newsletters
Membership Information \ Membership Application \ Volunteer Information \ Add Me to Mailing List \ Contact Us