Printable Application

 
African Violet Society of Oklahoma City
 
Application for Membership
 
___ Individual Membership            ___Joint Membership (2)
                    $20.00/yr.                                       $30.00/yr.
 
 
Name______________________________________________________
 
Address____________________________________________________
 
             ____________________________________________________
 
City_______________________________________________________
 
State_________________  Zip Code_____________________________
 
Phone_____________________________________________________
 
Email______________________________________________________
 
 
Do you want to be contacted by email?   ___Yes   ___No
 
Are you a member of AVSA?   ___Yes   ___No
 
 
I agree to the terms of membership, including the payment of dues annually and regular attendance at meetings.
 
 
________________________________________   _________________
                            Signature                                                 Date
 
Mail to:
AVS of OKC
Debbie Yeager, Sec.
217 W. Strasburg Way
Mustang, OK  73064