Print this form and send to the address below.

   Membership Application
   
	New membership _____     Renewal _____
   
   Category (please check just one!)
   Individual                    $25.00  _____
   Full-time student             $15.00  _____
   Library Subscription          $15.00  _____
   Family or household           $30.00  _____
   Contributing                  $40.00  _____
   Not-for-profit org            $50.00  _____
   Business/corporation          $100.00 _____
   Supporting                    $100.00 _____
   Donor                         $250.00 _____

   Total amount $_________________
   Payment by Credit Card (VISA/Mastercard Only)or 
   Check payable to FNPS

   Credit Card Number:___________________________________________
	
	Exp. Date:_______________

	Name as it appears on credit card:____________________________
   
   
	Name _________________________________________________________ 
   
	Company (if applicable) ______________________________________
   
	Street Address _______________________________________________  
   
	City _______________________ State ______ Zip ________________
   
	Phone ________________________________________________________
   
	Fax __________________________________________________________
   
	E-mail _______________________________________________________
   
	Chapter affiliation of your choice ___________________________
	(Will be assigned by location if left blank) 

   Please make your checks payable to FNPS and mail to:
   Florida Native Plant Society
   P.O. Box 278, 
   Melbourne FL 32902-0278