
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