WEST VIRGINIA NATIVE PLANT SOCIETY
Membership Registration
Name___________________________________________________________________
Address_________________________________________________________________
Phone________________________________ E-mail________________________________
I prefer to receive my newsletter by: ______USmail ______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: Judi White
WVNPS Treasurer
148 Wellesley Drive
Washington, WV 26181