Membership Application

Date: ____________________


Name of Applicant: __________________________________________________

Name of Applicant's Spouse: _________________________________________

Address: ____________________________________________________________
                                            (CITY)           (STATE)

Zip Code: _________________   Phone: ________________________________
                                           (HOME)        (BUSINESS)

E-MAIL: _____________________________________________________________

Occupation: _________________________________________________________

Business Address: ___________________________________________________
                                            (CITY)           (STATE)

Do you grow orchids as a hobby? ________  Profession: _______________

Are you interested in Orchid Education Courses? _____________________

Are you a member of the American Orchid Society? ____________________

Application received from: __________________________________________

Dues:
Individual Calendar Year Dues: $25.00
Doubles Calendar Year Dues: $35.00
Family Calendar Year Dues: $45.00

Check for membership payable to East Everglades Orchid Society, Inc.
We meet on the 4th Tuesday of each month.

Enclosed is: $___________

Mail application and check to:

     East Everglades Orchid Society
     c/o Donna Taylor
     9975 SW 196 Street
     Miami, FL  33157                               OFFICIAL USE ONLY
                                                    [  ] Treasurer
                                                    [  ] Labels
                                                    [  ] Secretary