Horticultural Inspection Society - Southern Chapter: Membership Application Form

2009 Membership Application Form Horticultural Inspection Society - Southern Chapter NOTE: Membership dues run from October 1 - September 30 of each year.
Mr. Mrs. Ms. Dr. Name:
Agency/Organization:
Position:
Work Address:
City:	State:	Zip:
Work Phone Number:
Home Address
City:	State:	Zip:
Home Phone Number Email Address:
Please check which type of membership: • Regular Membership - state employees engaged in plant pest inspection work as inspectors or as supervisors, in field, laboratory or office, other than administrative personnel. • Complimentary Membership- awarded at the discretion of this chapters executive committee. Date awarded by executive committee: • Associate Membership - all other interested parties not meeting the above criteria.
Please return this form and $15.00 for regular and associate membership for dues to: Beverly Bewley HISSC Secretary PO Box 1025 Lamar, AR 72846 beverly.bewley@aspb.ar.gov
FOR OFFICE USE ONLY
Received By:
Amount Received: $ Date Received: Check # or Cash: Process Date:
Membership Type: REG: COMP: ASSOC:
Secretary:
Treasurer:
Notes:
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