BRITISH STREPTOCARPUS SOCIETY

British Streptocarpus Society

(To print out this form, click on File ..... Print)

MEMBERSHIP APPLICATION FORM

The Membership year runs from 1st April to 31st March

[Subscriptions: UK - £6, Overseas - £8, U.S.$12 or 12 euros]

To assist the Society in planning for the future, it would be appreciated if you would answer the following questions (please circle your response) -

How many streptocarpus do you grow?

1-10

11-20

21-50

more than 50

Do you grow HYBRIDS? - YES / NO

Do you grow SPECIES? - YES / NO

Please PRINT your details -

TITLE(Mr/Mrs/Miss/Ms) ..................... INITIALS .......................

SURNAME.........................................................................................................................

ADDRESS..........................................................................................................................

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POST CODE / ZIP .......................................TELEPHONE ...................................................

DATE ............................................EMAIL .........................................................................

Please send this form and your remittance to -

UK and EUROPE -	USA and CANADA -
*(cheque payable to BSS)*	*(check payable to Dale Martens)*
Peter Pinches	Dale Martens
72 Coopers Road	1247 Island View Drive
Handsworth Wood	Sherrard
Birmingham	Illinois 61281
B20 2JX	USA

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