"People and Gopher Tortoises, at Home and in Citrus County"

Name____________________________________________________

Adress___________________________________________________

           __________________________________ Zip ______________

E-mail____________________________________________________

Affiliation__________________________________________________

I have enclosed $ 15.00 donation for the Program on May 20. ________

I have also included $ 35.00 for membership in GTCI. _______

Total amount _________


Send this form with enclosed payment to the adress below.

Ashton Biodiversity Research and Preservation Institute, Inc.
Gopher Tortoise Conservation Initiative
14260 - 331 W. Newberry Rd.
Newberry, FL 32669
Tortfarm@aol.com
352 - 495 - 7449 Phone
352 - 495 - 7433 Fax

EIN NO. 59-3613952    ABRPI sollicitation No. N9000005237