Application Form for Membership

of the Wild Flower Society

Diary required?    Yes     No

Name: ______________________________________

Title: _______________________________________

Postal Address including postcode:

____________________________________________

____________________________________________

____________________________________________

____________________________________________

Telephone Number:_____________________________

E-mail Address:________________________________

NB: if you wish to share a magazine, please state who with:

____________________________________________

Date of Birth (Junior only) ________________________

Amount enclosed:_______________________________

Please tell us how you found this site: