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