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MEMBERSHIP APPLICATION
Print out this application and mail or fax it to the address below with your credit card information or a check.
Full Name
Company (if relevant)			Dept:
Address
City
State			Postal Code:
Country
Phone	Office	Home	Fax
Email
Membership Details
Category: Circle or check	__ Standard $45 __ Subscriber $45	__ Family $45 __ Three-year $120	__Donator $500 __ Life $1000 (one time only)
Directory	__ Click if you do not want to be included in the online directory
Palms Direct Air Delivery	Included
Palms Delivery (non USA - Airmail)	Include an extra $28 if you want your Palms sent by airmail (optional)
Is this a gift membership? (Circle)	Yes	No
Total due
To pay by credit card, please complete form below (or send a check made payable to the IPS)
Full Name on credit card:
Credit Card No.			Card(Circle): MC or VISA
Expiration:	Month:	Year:
Print this registration form and mail to address below or fax to USA (512) 607-6468. International Palm Society 6913 Poncha Pass Austin, TX 78749, USA Your membership will be activated when your payment has been processed.