American Camellia Society - New Cultivar Registration Form

American Camellia Society - In Memoriam / In Honor Of New Cultivar Naming Information
Applicant Email*
example@example.com
Date*

MonthDayYear
Applicant Name*

First Name or First Applicant Last Name or Second Applicant
Applicant Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Applicant Phone Number*
Cultivar Originated and Propagated By
Originator same as applicant*

Originator is same as ApplicantOriginator is not the same as Applicant - Fill in fields below
Originator Name
Originator City and State and Country (if nor U.S.)
Propagator Status*

Propagator is same as ApplicantPropagator is same as OriginatorPropagator is not the same as the Applicant or the Originator - Fill in fields below
Propagator Name
Propagator City and State and Country (if nor U.S.)

American Camellia Society - In Memoriam / In Honor Of New Cultivar Naming Information