Date: ____________________


Name of Applicant: __________________________________________________

Name of Applicant's Spouse: _____________________________________________

Address: ____________________________________________________________
                                            (CITY)           (STATE)

Zip Code: _________________   Phone: ________________________________
                                           (HOME)        (BUSINESS)

E-MAIL: _____________________________________________________________

Occupation: _________________________________________________________

Do you grow orchids as a hobby? ________  

Are you a member of the American Orchid Society (AOS)? _____________________

Are you a member of the Cymbidium Society of America (CSA)?_________________

Are you a member of the Orchid Digest? _______________

Predominant growing space used is:

Window sill? _______
Under lights? ______
Greenhouse? ________
Outdoors? __________

Dues:
Individual Dues: $25.00 
Doubles Dues: $30.00
Family Plan Dues: $35.00
Student Dues: $15.00

Check for membership payable to Coastal Valley Orchid Society
We meet on the 3rd Tuesday of each month.

Enclosed is: $___________

Mail application and check to:

     Coastal Valley Orchid Society
     c/o Heather Quinn, Treasurer
     4549 Titan Ave.
     Lompoc, CA.  93436
                                                    OFFICIAL USE ONLY
                                                    [  ] Treasurer
                                                    [  ] Membership Listing