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The Evergreen State College

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Membership Form

First Name:
Middle Initial:
Last Name:

Street Address:
City:
State:
Zip Code:

Home Phone Number:
Work Phone Number:

Email:

Household Members (For memberships at $100 level and above)
Total Number of Household Members:

Amount
$   Please enter the exact amount 

Method of Payment
Check
Money Order
Bill me (To pay in full by check or money order)

Installment payments:
Please contact us at (360) 867-6894

If your contribution is $60 or more, you may choose one CD (two if pledging $100 or $150, four if joining at the $365 level) from the following categories. Please indicate your preferred genre:

Additional genre choice(s)

Contributions between $60 - $365 receive KAOS T-Shirts or KAOS Tote Bags (while supplies last). Please click the appropriate box below if your contribution is between $60 - $365.

All contributions of $150 and above receive both a KAOS T-Shirt and Tote Bag (while supplies last). Please click the appropriate boxes if your contribution is $150 and above.

The NEW KAOS Tote Bag featuring the KAOS logo in Black & Green on both sides of a large heavyweight all-cotton canvas bag. Great for groceries, books, LPs/CDs etc.

Tote Bag

The NEW KAOS T-shirt is a return to an old friend; Forest Green and All-Cotton with the KAOS logo in white and green on the front, our website in white on the back.

Small
Medium
Large
X-Large
XX-Large

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