Friends of the Vermont State House Membership Form

Donor Form
(circle one)

Enclosed is my check for ____________________________

to the Friends of the Vermont State House.

________________________________________________
(How you wish to be listed)

________________________________________________________
(Name)

________________________________________________________
(Address)

________________________________________________
(City) Zip

Checks should be made payable to Friends of the Vermont State House and mailed to:

Friends of the Vermont State House
2 Gov. Aiken Avenue,
Montpelier, VT 05633-5802

The Friends of the Vermont State House is a registered
501(c)3 nonprofit organization, tax I.D. number 03-0281983.