Mail form with payment of $15.00 single membership
or $25.00 for two (with the same mailing address) 

Address to: Maui Orchid Society, P.O. Box 2061, Kahului, HI  96733    or bring your payment in and join at our next meeting.

(  ) New Member       (  ) Membership Renewal

My Membership was referred by __________________________________________
                                    Name of MOS Member who referred you

             Membership free to applicants 80 years old and over.  Are you over 80 ? (   )

Name:______________________________________________________________  

Name:______________________________________________________________  

Address:____________________________________________________________  

City:__________________________________________ State______Zip________

Phone:  (R) ___________________________(B)__________________________   

Email:________________________

               (  ) New Member                           (   ) Membership Renewal

I wish to receive my newsletter via

Visiting the Website ________
 Regular US Mail________

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MOS Office Use:

Paid by: ___Cash ___Check                         Payment Amount $_____________

Clerk Initial______                                          Notes________________________

__________________________________________________________________

Receipt of Payment

Amount received $______________ Cash/ Check              Clerk: ________________

Date: ________________________ Name_____________________________________

                               Mahalo for supporting the Maui Orchid Society.