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SNOHOMISH COUNTY MYCOLOGICAL SOCIETY

Membership Enrollment Form

Name: _____________________________________________________      

Date: ___________________

Additional name if family membership: _________________________________________________________

Address, City, State, Zip+4: ________________________________________________________________

Telephone: _(_____)_____________________

E-mail address: ______________________________________

All newsletters will be via email unless otherwise instructed, the email version includes color graphics whereas the printed version is in B/W only.  Please check below if you would like the printed version.

Please  mail ____ my newsletter.

Circle Type of Membership:

$12.00 Family

$10.00 Individual

$  7.00 Student, Senior (age 62), or Senior Couple  

 

  Check here if this is a Membership Renewal  _______                                             

Mail completed form to:

SCMS
PO Box 2822
Everett, WA 98203-0822

Created: April 4, 2003