Central Missouri Orchid Society

2005 Membership Dues

Valid Jan 1 - Dec 31, 2005

Name ______________________________________________

Address ____________________________________________

City ________________________ State _______ Zip _______

 Phone (Home) ___________         Phone (Work) ____________

E-mail _____________________________________________

Will you receive your newsletter by e-mail? _________

Type of membership:

____ Individual Membership $15

____ Family Membership $15

            Family Member Names:         _______________________________

                                                            ________________________________

                                                            ________________________________

                                                            ________________________________

Please return this form with payment (checks should be made to “CMOS”) to:

Martha Routier

5601 N. Maple Ct.

Columbia, MO 65202