Yes, I want to join/renew (circle one) my membership in the John Clayton Chapter/VNPS

Name___________________________________________

Address_________________________________________ City_________________________

State__________________ Zip____________ Email__________________________________

Phone H(____)__________________ W(____)__________________

I wish to sign up the following for a gift membership:

Name___________________________________________

Address_________________________________________ City_________________________

State__________________ Zip____________ e-mail__________________________________

Phone H(____)________________ W(____)________________

___Student  $15         ___Sustaining  $100

___Individual $30       ___Life  $500

___Family  $40           ___Associate (groups)  $40, designate one person as delegate                 

___Patron  $50                          Delegate Name (for Group) _______________________________________

I wish to make an additional contribution to: ___VNPS, ___John Clayton Chapter in the amount of $___________.

This is a gift membership:  Please include a card with my name as donor __________________________________. 

I am interested in helping with the following:  ___Propagation/Plant Sale, ___Plant rescue/relocation, ___Fieldtrips, ___Telephoning, ___Art, ___Photography, ___Programs, ___Publications, ___Setting up and taking down at functions, ___Youth programs, ___Education Committee, ___Conservation Committee, ___Stewardship of native plants, ___Service on Chapter Board of Directors, and/or ___Service on State Board of Directors

I have ___time, ___little time, ___no time to participate as an active member.

Would you like to be listed in the Chapter Membership Directory available only to members?  yes___  no___

Send newsletter to Email above ___  or to home address___.