PSMS Membership Form

Print this page, fill out the form below and mail it with your check for one year's dues:
Single/ Family- $25, Full-time Student- $15 to:

Bernice Velategui, Membership Chair
2929 76th SE #504
Mercer Island, WA 98040

Name/Names: ________________________________________________________

Address: ____________________________________________________________

City: ________________________________ State: ________ Zip: _____________

Phone: (        )________________    Business Phone: (        )_________________

Occupation(s): _______________________________________________________

E-mail Address: _______________________________________________________

The Puget Sound Mycological Society is supported entirely by volunteers.
Please check areas in which you might occasionally be able contribute: