Membership Application
MEMBER INFORMATION
______________________________ ______________________________
Name (Last/First/M.I.) Nickname
______________________________ ______________________________
Street
Address City State ZIP Code
_____________________________
Date
of Birth (mm/dd/yy) r Female r Male
______________________________ ______________________________
Home
Phone Cell Phone
______________________________ ______________________________
E-Mail
Address Referred By
MEMBERSHIP ELECTION
Please make checks
payable to: c/o Membership
r Individual ($10)
r Household* ($15)
*Must
share same residence.
AREAS OF INTEREST
Please check all boxes
that apply:
r Gardening/Labor r Administrative
r Watering r Project Management
r Fund Raising r Research
r Technical r Event Planning
r
Other (specify)_______________________________________
MEMBER SIGNATURE
I hereby acknowledge that annual membership dues are non-refundable and membership will expire one year from the date in which this application has been signed.
________________________________ ________________________
Signature Date