I wish to begin or continue my membership in NOCI.

	Individual	____	@ $10.00	__________
	Junior	____	@ $0.00	__________
	Group	____	@ $25.00	__________

I wish to donate to help save endangered plants and habitat.

	[ ] $25.00	[ ] $50.00	[ ] $100.00	[ ] Other	Donation Amount __________
					Total __________

I wish to save trees by giving up paper newsletters;  I have verified that I am receiving
electronic notifications, and I'm willing to receive notice of meetings in only that way.

[ ] YES

[ ] NO

Name(s):	__________________________________________________________
Address:	__________________________________________________________
	__________________________________________________________
Signature:	__________________________________________________________
Optional Information:
Phone:	__________________________________________________________
E-mail:	__________________________________________________________
Occupation:	__________________________________________________________
Interests:	__________________________________________________________
Volunteer?	__________________________________________________________
How did you first learn about NOCI?	__________________________________________________________

A tax-receipt for your donation will be issued in February;  our Tax-Nbr is  86816 7198 RR0001.

Mail, with cheque payable to Native Orchid Conservation Inc, to:

Peggy BainardAcheson, NOCI Membership Chair P O Box 56025 Winnipeg MB R3B0G9