Haymarket Town & Country Garden Club Membership Application

WELCOME! Please upload a photo of yourself for our roster.
The Member Roster is printed,
but not published online.

The best size is 600 x 600 pixels.
The best format is JPG.
The best crop is a headshot
that includes shoulders and
has a simple background.
The date you first joined the club

Month 00Day 00Year 00
Change Date

Month 00Day 00Year 00
I am:*

A New MemberActive Offsite MemberRenewingMaking Changes
Privacy Notes

All our members agree to submit their addresses. Check here if you do not want your address published in our printed yearbook.
1. We do our best not to include last names online (website, Facebook, marketing). The exception is that the member wants or needs to use their last name.
2. This information is printed in our Membership Roster: Photo, Name, Partner (lifespan if desired), Year joined, Address, Phone(s), Birth Month and Date (no year), and Email(s)
3. Your image and or first name may be used on our website or for social media. No last names are used.
Name*
Spouse/Partner
Lifespan
0000-0000
Optional. If your spouse has passed, their name can be followed by their lifespan. i.e. Roger 1928-2017
Street Address*
City*
State*
2- letter
ZIP*
5 numbers
Email*

Confirmation Email
Birth Month*
Birth Date *
WE DO NOT ASK FOR THE YEAR
Phone Number 1*
Phone 1 is*

HomeWorkCell
Phone Number 2
Phone 2 is

HomeWorkCell
How did you learn about us?*

Referred by a memberWeb SearchFacebookA Garden Club Paid EventHaymarket DayOther
Member that referred you
Other ways you heard about us
Other garden or plant clubs to which you belong
Applicable certifications
example: Master Gardener, Flower Show Judge
Have you been, or will you be an Executive Board Member for any of the following?

PW Area Council of Garden ClubsNational Capitol Area Garden ClubsNational Garden ClubsCentral Atlantic Region of State Garden ClubsHaymarket Town & Country Garden Club
Other Board Positions
Check any areas that you would enjoy.

MembershipYouth ProjectsOur NewsletterFlower showsFundraisingCommunity OutreachPublicity
Other areas to get involved
PAYMENT METHOD $45 annual dues*

PAY BY CHECKPAY WITH CREDIT CARD
PAY BY CHECK
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