Membership Form
MEMBERSHIP APPLICATION OR RENEWAL FORM
Name _____________________________________________________________
First Last
Address ___________________________________________________________
Street
_______________________________________________________________
City State/Prov Zip Code
Phone _________________ E-mail ____________________________________
Enclosed is a check in the amount of $ _____________ in payment of dues for the year(s) _______________ .
Type of membership ________________________ New _____ Renewal _____
(See categories below)
Make check payable (in US funds) to Western Apicultural Society and mail to:
Western Apicultural Society
P.O. Box 956
Grants Pass, OR 97528
MEMBERSHIP RATES
Individual $ 10.00 US
Junior $ 7.50 US
Senior $ 7.50 US
Couple $ 15.00 US
Life $ 100.00 US
Couple Life $ 150.00 US
Commercial $ 50.00 US
Associate $ 100.00 US
Benefactor $ 500.00 US
Patron $ 1,000.00 US