New Member Application

APPLICATION FOR MEMBERSHIP

PREFERRED NAME(S) AND ADDRESS(ES) FOR MAILING:

Mr. Miss Mrs. Ms. ______________________________

Spouse __________________________

Address: ___________________________________________________________________

City _____________________ State _____ ZIP code __________________

Home Phone _______________ Cell: _______________

Email ____________________________

Preferred Name(s) for Name Tag: _____________________________________________

Birthday(s) ___ Month ___ Day ___ Month ___ Day

Referred by ________________________________________ (Name of member or mentor)

INTEREST IN HERBS (CHECK ALL THAT APPLY)

___ Culinary ___ Introducing children to “herbs for use and delight”

___ Decorative uses and drying ___ Potpourri, or creams and lotions

___ Personal Gardening ___ Cultural uses, present or past

___ Historical landscape ___ Research, teaching

___ Plant Symbolism ___ Presently growing herbs

___ Native Plants ___ Other ________________________________

FAVORITE VOLUNTEER ACTIVITIES WOULD INCLUDE

___ Gardening ___ Herb Forum

___ Host Meeting ___ Educational Activities

___ Serve on Committees (What capabilities and skills do you have from past experience?)

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* In what ways will being a member be useful to you? (Please attach additional sheets if necessary.)

* How long have you studied herbs and in what ways have you used them? (Please attach additional sheets if necessary.)

* Have you ever written any articles or papers on herbs or the uses of them? (If so, please list titles, publication dates, and publishing companies). (Please attach additional sheets if necessary.)

* Have you ever lectured on or prepared an exhibit of herbs? (Please describe and attach additional sheets if necessary.)

* Of what if any horticultural organization(s) are you a member? (Please attach additional sheets if necessary.)

* Do you understand that the Pioneer Unit is governed by the principals, constitution, and by-laws of The Herb Society of America? ___ Yes ___ No

Dues are itemized and identified below and are pro-rated according to month in which you join. For example, if one joins mid-year, dues would be $33.48 for six months and then pay full renewal amount of $67 come May 1 for following year. After you have visited three monthly meetings and attended a Unit-sponsored garden workday for a minimum of two hours participation at each of the Unit’s gardens, you may submit your application with payment of required dues to the Membership Chair. Please circle appropriate membership selection and make your check payable to HSA Pioneer Unit.

DUES

Active – Single $67.00 $12.00 Local Unit

Active – Joint $98.00 $18.00 Local Unit

Affiliate – Single $12.00 $12.00 Local Unit

Affiliate – Joint $18.00 $18.00 Local Unit

Membership Badge Cost New Members $5.00 Each

$55.00 HSA National

$80.00 HSA National

Signature(s) __________________________________ Date ____________________

***Please attach a short bio about yourself to help us welcome and introduce you as our new member. Thank you and we look forward to your membership in our Unit!***

Please mail application with your check for $72 (includes one-time member badge fee of $5) payable to HSA Pioneer Unit, Attn: Membership, PO Box 123, Round Top TX 78954-0023.

OFFICE USE

Meeting Dates: ______________________________________________________________

Garden Hours and Date(s): _____________________________________________________

Check Received: __________

Notes:

Rev 08-May-2014

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