Please print the following page, fill it in, attach a cheque and mail:

Mail: Georgetown Horticultural Society, P.O. Box 91521, Georgetown, ON L7G 3G2

Name: ____________________________________________

Address: _________________________________________

Phone No. _________________________________________

Email: ____________________________________________

Membership Type: _________________________________

Single - $10 Family - $15 Senior - $8 Senior Family - $10

Would you like to be contacted by phone or email? ____________

Permission to print the above information on our membership list for use by the Georgetown Horticultural Society and for publication in our yearbook.

Date: _____________________________

Signature: ______________________________________

Someone will contact you as soon as we receive your membership form.