Membership Application Complete the form below to join the Middlesex Land Trust. Once complete, click on the button at the bottom of the page to pay with PayPal. Membership Level Individual – $25 Sustaining – $50 Patron – $100 Guarantor – $250 Benefactor – $500 Endower – $750 Conservator – $1000 DonationIf you wish to make an additional contribution to the land trust, you may enter the amount here: If you are a new member, please tell us how you heard about us.Member Information – Name* First Last Email* Enter Email Confirm Email Phone(Optional)Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total $0.00