Jacksonville Herpetological Society

PO Box 37336
Jacksonville, Florida 32236-7336

Membership is from June to June

Membership Application / Renewal

______NEW                   _____ RENEWAL

Name_______________________________________________________________________________

P lease print clearly

Address: ________________________________________________________________________________

City: ______________________________ State: ______________________ Zip: __________________

Telephone Numbers:

Home: __________________ Work: _____________________ Cell: ________________________

E-mail: ___________________________________________________________________

Herp Interests:____________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

Membership Type:

______Single $20.00 1 Year        _____ Family $30.00 1 Year

Please make checks payable to Jacksonville Herpetological Society

You may mail this application to the above address or bring application and fees to any
 meeting. Dues are due in June of each year.  Newly elected Board Members take office each July.

Please fill out this form completely whether you are a new or renewing member. This form will
 only be seen by the membership chairperson and/or other board members. If you do NOT want your address,
phone number or email address listed, please write it across this form somewhere.