Please print this out and mail it to:
Colorado Herpetological Society, Inc
PO Box 150381
Lakewood, CO 80215
Your Name __________________________________________________________________________
Address ____________________________________________________________________________
____________________________________________________________________________
City _______________________________ State ______________ Zip Code ___________
Country ____________________________
Phone Number (with Area Code) ____________________________
E-mail address ___________________________________________
Name for 2nd Membership Card (Family members only) _________________________________
Other Family Members (Famly Memberships Only), please list ages of any children:
____________________________________________________________________________________
Where did you hear about us ________________________________________________________
Where do you attend school (Student Memberships Only) ______________________________
Where do you teach (Educators Only) ________________________________________________
What are your intersests in Herpetology ____________________________________________
Do you have any special skills or background that might be of interest to our
membership or which you would like to use to help the CHS:
____________________________________________________________________________________
Membership: (Check One)
_____ Individual ($20.00/year)
_____ Students and Educators ($17.50/year)
_____ Family ($22.50/year)
_____ Contributing ($35.00/year)
_____ Corporate Sponser ($50.00/year)
_____ Newsletter Member (Out of State Only, $17.500/year)
Outside of USA:
_____ Canada and Mexico ($22.50 US/year)
_____ Europe ($27.50 US/yr)
_____ Australia, New Zealand, Japan ($30.00 US/year)
_____ Rest of World ($27.50 US/year)
The names, phone numbers, and interests of all new members are routinely published
each month in the Cold Blooded News. This information is also recapped annually
in our Membership Directory and Resource Guide. Please check as indicated if you
wish to modify this:
_____ Please do not publish my name
_____ Please do not publish my interests
_____ Please do not publish my phone number
_____ Please do not publish my e-mail address
_____ Please also publish my address
____________________________________________________________________________________