MEMBERSHIP APPLICATION

Name________________________________________________________

Address ______________________________________________________________
                             Street                                                      Apt.#            PO Box

City _______________________State___________ Zip __________________

Business Affiliation _______________Phone _____________________________

FAX __________________________E-Mail _______________________________

Check appropriate membership category

INDIVIDUAL                                    INSTITUTIONAL

__ Student - $10                                 __ General - $100

__General - $20                                 __ Contributing - $500

__Contributing - $50                          __ Donor - $501-$10,000

__Donor - $51-500                           __ Patron - $10,000

Mail completed form and check (made payable to GA-EPPC) to:
Georgia Exotic Pest Plant Council
Elaine Nash
3390 Hwy. 20 SE
Conyers, GA 30013-2866