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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

__ One year $55  
__ One year with Airmail delivery (NON USA) $83
__ Three year with Airmail delivery (NON USA) $150
__ Three year with Airmail delivery (NON USA) $234

Directory
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) 870.9366
International Palm Society
9300 Sandstone St. Austin, TX 78737, USA

Your membership will be activated when your payment has been processed.