Membership Application / Donation Form

ALBERTA NATIVE PLANT COUNCIL

To apply for membership please complete all questions. This information is used for ANPC records by the membership secretary and treasurer only.
Name*

First NameLast Name
Names of Additional members (for use when purchasing Family, Corporate or more than one Membership)
Address*

Street Address

Street Address Line 2

City Province

Postal Code
E-mail*
Phone Number*

Area CodePhone Number
Date
Membership Type

RenewalNew
Membership and Donation Options
prevnext( X )
Individual$25.00CAD

Quantity

Student$10.00CAD

Quantity

Senior (65+)$10.00CAD

Quantity

Family -any 2 adults and all children under 18 years of age$45.00CAD

Quantity

Corporate - up to 5 employees$100.00CAD

Quantity

Lifetime$500.00CAD

Quantity

Donation$15.00CAD

Donation$25.00CAD

Donation$35.00CAD

Donation$50.00CAD

Donation$75.00CAD

Donation$100.00CAD

Wildflowers of Whitehorse Wildland Prov. Park$20.00CAD
Please use this price for Canadian orders

Quantity
Item subtotal:$0.00CAD

Wildflowers of Whitehorse Wildland Prov. Park$35.00CAD
Please use this price for International orders

Quantity
Item subtotal:$0.00CAD

Total $0.00CAD
Consent to receive emails from ANPC*

YesNo
*Please check these boxes ONLY if you are making a payment for membership (new or renewal).
Consent to receive Iris newsletter by email*

YesNo
Consent to receive info emails*

YesNo
Register for ANPC Native Plant Challenge*

YesNo
*If you make a donation to ANPC please answer the following questions:
Please use my donation for:

Where most neededFor conservationFor education
I would like my donation to remain anonymous

YesNo
I would like to be included on the ANPC's contractor/botanist list
Should be Empty:

ALBERTA NATIVE PLANT COUNCIL