Southwestern Chapter,
Michigan Botanical
Club
 Please
print out this form and mail to the address at the bottom.
Name_____________________________________________________
Address
___________________________________________________
City____________________________
State___________________________
Zip code or postal code
_________________
COUNTRY _______________________
Office Phone______________________
Home Phone ______________________
email_____________________________
Do you wish to have this
information published in our membership directory?
_____yes ______
no
Family membership: $25.00 (U.S. funds)
Individual membership: $22.00 (U.S. funds)
Student membership: $14.00 (U.S. funds)
Please make check payable to: Michigan Botanical Club, Southwestern Chapter.
Send this form with check to:
Donna Schumann,
Treasurer
809 Dukeshire Ave.
Portage, MI 49024.
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