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Please
print out this form and mail to the address at the bottom. Please
print out this form and mail to the address at the bottom.| Year 2007 | MBC Special Membership Form |
|
| Your Name: | ____________________________________________ | |
| Institution: | ____________________________________________ | |
| Department: | ____________________________________________ | |
| Address to mail The Botanist to: |
____________________________________________ ____________________________________________ |
|
| City: | ________________________ | Zip/Postal code:_____________ |
| State/Province | ________________________ | |
| Country: | ________________________ | |
| Phone: | ________________________ | |
| Fax #: | ________________________ | |
| E-mail: | ________________________ | |
| Payment | $_21.00_ | subscriptions for ONE YEAR only |
| Contribution for Michigan Botanical Foundation: | $__________ | |
| Total: | $__________ (U.S. funds) Check Number ______ | |
|
Please Mail to: |
Irene Eiseman MBC Affiliated Membership Chair 1873 Pierce Road Chelsea, Michigan 48118 |
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This page updated on 12/01/07