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. 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
Membership: O Student O Individual O 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? O Yes O No
AmEx Info:
Date
Amount
Exp. Date
Charge to my AmEx card no.
Signature