NRS MEMBERSHIP APPLICATION FORM

Nanaimo Rhododendron Society Membership Application Form

 

 

 

Box 241, #101-5170 Dunster Rd., Nanaimo, BC V9T 6M4

Website: http://nanaimorhodos.ca     email:   rhodomentum@nanaimorhodos.ca

 

Cheques should be made payable to: The Nanaimo Rhododendron Society

Rates: Individual $40, family $45 ; associate (member of another chapter) $10, or $15(family), Student $10
this includes name tag & membership in the American Rhododendron Society.

Please print clearly

 

Name: _______________________________________________________________________

 

Phone: _________________________         Email: _____________________________________ ’

 

Address: ________________________________________________

 

City: ___________________________         Postal Code: ___________________

I/we apply to the board of the Nanaimo Rhododendron Society for membership.

Choose type of membership:

Individual____       Family____           Associate_____   Associate Family____           Student____

 

• I agree to include my phone, address & email for the Society’s membership list

 

• I agree that my email can be sent to the American Rhododendron Society

 

• I consent to use of my (circle one only)   email, phone, address in the official club register.

 

 

 

_________________________          Date: _________________________

Signed