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