Print and fill out this form or supply the same information. Make checks payable to Oklahoma Native Plant Society and mail to Oklahoma Native Plant Society, 2435 South Peoria, Tulsa, OK 74114. Dues include subscription to Gaillardia and are tax deductible.

Name: ____________________________________________________________

Affiliation: (School, Business, or Avocation) _______________________________

Address: ___________________________________________________________

    _____________________________________________________________

    _____________________________________________________________

Chapter Affiliation:

__ Central (OKC)   

__ Crosstimbers (Stillwater)  

__ Northeast (Tulsa )  

__Mycology (statewide)

Home Phone: (______)_______________

Cell Phone: (______)_______________

Office Phone: (______)_______________

E mail: ______________________________________________________________

Please do not list my phone in the ONPS directory __

Annual Membership Choice:

__ $15 Individual,  

__ $20 Family,  

__ $5 Student

 Or. . . Life Membership Choice:

__ $250 Individual,  

__ $350 Family

Add $5 __ to cover cost of printing and mailing a complete ONPS directory, or

Add $2 __ to cover cost of mailing a CD with a complete ONPS directory in PDF format if desired

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