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:

Bart & Marielle Eykemans,
TMSNAB
P.O. Box 2635
Port Angeles, WA 98362
USA

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

Please print.

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: