2004 MNPS Annual Conference Registration Form

Name	__________________________________________________
Street	__________________________________________________
City	__________________________________________________
State	______	Zip Code	__________	County	_______________
Home Phone	__________________________________________________
Work Phone	__________________________________________________
E-mail	__________________________________________________

____ I am a current Native Plant Society member

Registration Fee	__________
Saturday Social	__________
Membership Dues	__________
Additional Donation	__________
Total Enclosed	__________

____ I would like a vegetarian lunch

Membership Dues: ____ New ____ Renewal
Membership is for 12 months.

• ____ $15  Student/Limited Income
• ____ $25  Individual
• ____ $35  Double: 2nd member
• ____ $250 Lifetime
• ____ Do not list me in membership directory.
• ____ Do not send me email announcements.

Please include me on the MNPS providers list as a:

• ____ native plant propagator or grower
• ____ native plant supplier
• ____ native plant landscape or garden professional

Please make checks payable to Maryland Native Plant Society and mail to:

MNPS allows members of other Native Plant Societies to register at MNPS member's rate. Please consider supporting MNPS.