The St. Louis Herpetological Society Membership Application

 

Name ____________________________________________________ Date _____________________

Address_________________________________________________________________

City___________________________ State__________ Zip Code _________________

Phone ______________________ Email ______________________________________

May we include you in our membership directory? YES/NO

Primary interest in Herpetology_____________________________________________

________________________________________________________________________

Occupation (Optional) ____________________________________________________

Employer (Optional) ______________________________________________________

New Member ________ Renewal Member ________

Address Change ________

Annual Dues:

Individual ($20) __________ Family ($23) __________ Sustaining ($250)__________

Lifetime Memberships:

Lifetime ($500)__________ Patron ($1000)__________

 

Please send form and  payment to:

St. Louis Herpetological Society

P.O. Box 410346

St. Louis, MO 63141-0346