Gift Membership Application

International Phalaenopsis Alliance
Gift Membership Application
Note: As a non-profit organization we must make all attempts to keep mailing cost to a minimum. Please mail your new membership application along with the appropriate remittance to the address as shown on following confirmation page.
We Do Not Invoice for new member fees

The IPA does not charge for shipping AND we do accept and or

Applicant Information: . . . Directions ... Please type in this form on your computer screen, then go to confirmation page and verify that all the information is correct (if applicable, type in Credit Card Information), then print out, sign, and mail.

First Name:
Last Name:
Company:
Address:

City:

State/
Province:

Postal/
Zip Code:

Country

Home Phone:		Work Phone:
FAX:		Email:

Select the Gift Membership:

Questionnaire: . . . Please select from the below which best describes the current orchid growing status of the recipient

They grow in/on a . . .	They are a . . . grower	They grow for a . . .
Greenhouse	Beginner	Hobby
Windowsill	Intermediate	Commercial Grower
Under Lights	Advanced

Gift Givers Information:

First Name:
Last Name:
Company:
Address:

City:

State/
Province:

Postal/
Zip Code:

Country

Home Phone:		Work Phone:
FAX:		Email:

Select Payment Method: . . . Payable in US Dollars

Check Number Total: $

Applicant Information: . . . Directions ... Please type in this form on your computer screen, then go to confirmation page (NEXT) and verify that all the information is correct (if applicable, type in Credit Card Information), then print out, sign, and mail.