APPLICATION FOR MEMBERSHIP
PREFERRED NAME(S) AND ADDRESS(ES) FOR MAILING:
Mr. Miss Mrs. Ms. ______________________________
Spouse __________________________
Address: ___________________________________________________________________
City _____________________ State _____ ZIP code __________________
Home Phone _______________ Cell: _______________
Email ____________________________
Preferred Name(s) for Name Tag: _____________________________________________
Birthday(s) ___ Month ___ Day ___ Month ___ Day
Referred by ________________________________________ (Name of member or mentor)
INTEREST IN HERBS (CHECK ALL THAT APPLY)
___ Culinary ___ Introducing children to “herbs for use and delight”
___ Decorative uses and drying ___ Potpourri, or creams and lotions
___ Personal Gardening ___ Cultural uses, present or past
___ Historical landscape ___ Research, teaching
___ Plant Symbolism ___ Presently growing herbs
___ Native Plants ___ Other ________________________________
FAVORITE VOLUNTEER ACTIVITIES WOULD INCLUDE
___ Gardening ___ Herb Forum
___ Host Meeting ___ Educational Activities
___ Serve on Committees (What capabilities and skills do you have from past experience?)
___________________________________________________________________________
___________________________________________________________________________
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* In what ways will being a member be useful to you? (Please attach additional sheets if necessary.)
* How long have you studied herbs and in what ways have you used them? (Please attach additional sheets if necessary.)
* Have you ever written any articles or papers on herbs or the uses of them? (If so, please list titles, publication dates, and publishing companies). (Please attach additional sheets if necessary.)
* Have you ever lectured on or prepared an exhibit of herbs? (Please describe and attach additional sheets if necessary.)
* Of what if any horticultural organization(s) are you a member? (Please attach additional sheets if necessary.)
* Do you understand that the Pioneer Unit is governed by the principals, constitution, and by-laws of The Herb Society of America? ___ Yes ___ No
Dues are itemized and identified below and are pro-rated according to month in which you join. For example, if one joins mid-year, dues would be $33.48 for six months and then pay full renewal amount of $67 come May 1 for following year. After you have visited three monthly meetings and attended a Unit-sponsored garden workday for a minimum of two hours participation at each of the Unit’s gardens, you may submit your application with payment of required dues to the Membership Chair. Please circle appropriate membership selection and make your check payable to HSA Pioneer Unit.
DUES
Active – Single $67.00 $12.00 Local Unit
Active – Joint $98.00 $18.00 Local Unit
Affiliate – Single $12.00 $12.00 Local Unit
Affiliate – Joint $18.00 $18.00 Local Unit
Membership Badge Cost New Members $5.00 Each
$55.00 HSA National
$80.00 HSA National
Signature(s) __________________________________ Date ____________________
***Please attach a short bio about yourself to help us welcome and introduce you as our new member. Thank you and we look forward to your membership in our Unit!***
Please mail application with your check for $72 (includes one-time member badge fee of $5) payable to HSA Pioneer Unit, Attn: Membership, PO Box 123, Round Top TX 78954-0023.
OFFICE USE
Meeting Dates: ______________________________________________________________
Garden Hours and Date(s): _____________________________________________________
Check Received: __________
Notes:
Rev 08-May-2014
