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Membership Application Form
Send this form to: International Hemp Association, Postbus 75007, 1070 AA Amsterdam, the Netherlands. Please enclose the annual fee, preferably as an International Postal Money Order or an American Express or Thomas Cook Money Order. US$ personal checks accepted. 1996 membership fees, Student: US $25 (Dfl.40) Individual: US $50 (Dfl.80) Substaining/Business: US $100 (Dfl.160) or more! (PLEASE PRINT)
Name/organisation ___________________________________________________
Street address _______________________________________________________
City ___________________________ State/Province ______________________
Postal Code _____________________ Country ___________________________
Tel ____________________ Fax ___________________ e-mail _____________
Membership: 0 Student 0 Individual 0 Sustaining/Business
Main field of interest or expertise ______________________________________
Can we include your name, address and field of interest or expertise in a membership list to be made available to our members? 0 Yes 0 No
AmEx Info: Date _________ Amount ____________ Exp. Date _____________
Charge to my AmEx card no. ________________ Signature _________________