Membership Form

Thank you for your gift of membership! Use this form to purchase up to two memberships for yourself, as a gift, or to renew a membership.

To purchase more than two memberships, return to the form to make additional transactions or make your purchase by phone by calling Lori Howard at (607) 255-8734.

Membership Levels

$25 Student/Senior
$25 Plantations Volunteer
$50 Individual
$75 Household
$100 Friend
$101–$499 Sustaining Member
$500–$999 Charter Society
$1,000–$4,999 Plantations Sponsor
$5,000+ Tower Club

Your Billing Information

First Name: *

Last Name: *

Address: *

City: *

State/Province: *

Zip: *

Country: *

Phone: *

Please use the format xxx-xxx-xxxx

Email: *

First membership

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Membership Type: *

Membership Gift:

Member Name: *

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Cornell Class Year:

Spouse/Partner's Name and Class:

Member Address: *

City: *

State: *

Zip: *

Country: *

Member Phone: *

Please use the format xxx-xxx-xxxx

Member Email: *

Second membership (optional)

Membership Type:

Membership Gift:

Member Name:

Include first and last name

Cornell Class Year:

Spouse/Partner's Name and Class:

Member Address:

City:

State:

Zip:

Country:

Member Phone:

Please use the format xxx-xxx-xxxx

Member Email:

Payment Information

Credit Card Number: *

Your card information will be transmitted securely to our credit card processor. Please use digits only, no dashes or spaces.

Expiration Date: *

Please use the format MMYY

Card Security Code: *

Card security code info

Total Amount: * $

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You will be charged the amout above for your selected membership(s) and receive an email confirmation of your purchase.

Membership Form

Membership Levels

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