New Member Application This for

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. This form is for mail application by Credit Card or Check only

We Do Not Invoice for new member fees

Applicant Information: . . . Directions ... Please complete this form, press next to go to confirmation page to 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 Your Membership:

Subscribe to the Phal Digest , . . . Member benefit . . . No Charge	Subscribe to the Phal Digest YES NO
One Year Membership . . . US and Canada	US$ 36.00
Two Year Membership . . . US and Canada	US$ 70.00
One Year Membership . . . Overseas	US$ 60.00
Two Year Membership . . . Overseas	US$ 115.00
Associate Membership . . . US, Canada and Overseas Only one Associate Member may be added to any membership in same household. They will receive all the benefits as a full Member except they will not receive a copy of Phalaenopsis	US$ 5.00 *Only at time of primary registrants enrollment. Not available separately

Select a Color Fund Donation: . . . Optional but very, very appreciated

Color images in the IPA Journal's, 'Phalaenopsis' are funded by donations from the membership... Please consider a contribution with your Gift Membership to help support this popular part of the Journal's efforts to continue providing quality color in all issues.

US$ 10.00
US$ 25.00
US$ 50.00
US$ 100.00
Thanks, but not at this time

Select Payment Method: . . . Payable in US Dollars

Check Number Total: $

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IPA 2010 . . . Membership Renewal Application