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Membership - the Maple Society (only the North American Branch)

Application for Membership of the North American Branch.

Please fill out the following form and send the form and payment to:

Jan Kelley,
TMSNAB
P.O. Box 1130
Drain, OR 97435
USA

Make checks or money orders payable to "The Maple Society, North American Branch (TMSNAB)" and drawn on a US bank account.

Please print.

Name:  
Company:  
Address:  
City, St/Pr:  
City, St/Pr:  
Telephone: work/home (      )
E-Mail:  
Payment type and amount: Check: VISA: Mastercard:
Card number: Expiry date:
Card Validation Code (last 3 digits on back side of credit card):
Signature: Date:
Gift Membership Given By:

Annual Subscription Rates are as follows (please circle choice):

Individual:
Family:
Associate / Library:
Corporate / Business:
Sustaining:
Life Membership (Individual):
Life Membership (Couple):
$35
$50
$50
$100 (includes opportunity for ad in each newsletter)
$125
$750
$1000
To be filled out by TMSNAB Membership Secretary:
Date Received:
Processed:
First Issue: