International Mushroom Dye Institute membership form:

 

YES! I, (or We, as a group) want to become a supporting member of the IMDI.

Date:_______________

NAME______________________________________________________________________

ADDRESS__________________________________________________________________

CITY / STATE / COUNTRY:_________________________________________________________

ZIP CODE___________________ E-MAIL ADDRESS______________________

Membership dues - $10.00
__________
Donation for IMDI Library
__________
Donation for Scholarship Fund
__________
   
Total amount enclosed
__________

 

Special Interests, questions, or comments:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

(The IMDI was established under IRS Code Section 501(c) (3) as a non-profit organization for educational purposes. All donations are tax-deductible to the extent as allowed by law.)


Please send Checks or International Money Orders to:
IMDI,
P.O. Box 703,
Mendocino, CA. USA, 95460

 

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