WEST VIRGINIA NATIVE PLANT SOCIETY

Membership Registration

Name___________________________________________________________________

Address_________________________________________________________________

Phone________________________________ E-mail________________________________

I prefer to receive my newsletter by:              ______US mail   ______e-mail (helps reduce our costs).

Membership Dues (For calendar year January through December 31):

__$ 12 Regular membership                               Optional Chapter Dues

__$ 8 Student membership                                __$ 6.00 Kanawha Valley Chapter  (Charleston)

__$200 Lifetime membership                             __$ 6.00 Tri-State Chapter (Huntington)

Make check payable to: The West Virginia Native Plant Society

I wish to make an additional contribution to WVNPS in the amount of: ______________

This is a Gift Membership. Please include a card with my name as donor:___________________________________

I am interested or skilled in the following:
__Field botany                                           __Serving in a leadership capacity
__Botanical art                                           __Photography    
__Public speaking                                       __Propagation
__Publications                                            __Display development                      
__Leading field trips                                    __Stewardship of wildflower plantings or preserves

RELEASE AND WAIVER OF LIABILITY

By my signature below, I assume all risk of injury to myself and all risk of damage to and loss of my property arising out of my participation in activities of the West Virginia Native Plant Society (WVNPS). I am in proper physical health and conditioning for activities that I participate in, and release and forever discharge the WVNPS and any private property owners who provide space for activities from any and all liability for any injury, including death, and for property damage or loss which may be suffered by me, arising out of or in any way connected with my participation in WVNPS activities.

__________________________________________ ____________________

SIGNATURE/ DATE

Return to: West Virginia Native Plant Society; 6128 Gideon Rd. Huntington, WV 25705