Membership Application Form

Send this form to: International Hemp Association, Postbus 75007, 1070AA Amsterdam, the Netherlands. Please enclose the annual fee, preferably as an International Postal Money Order or an American Express or Thomas Cook Money Order. US$ personal checks accepted. 1999 membership fees, Student: US $25 (NLG l.50) Individual: US$50 (NLG 100) Sustaining/Business/Library: US $100 (NLG 200) or more! (PLEASE PRINT)


Name/organisation ___________________________________________________

Street address _______________________________________________________

City ___________________________ State/Province ______________________

Postal Code _____________________ Country ___________________________

Tel ____________________ Fax ___________________ e-mail _____________

Membership: 0 Student 0 Individual 0 Sustaining/Business


Main field of interest or expertise ______________________________________

Can we include your name, address and field of interest or expertise in a membership

list to be made available to our members? ( ) Yes ( ) No

Please charge my American Express, Visa, MasterCard (circle one)

Info: Date ___________ Amount _____________ Exp. Date ______________

Charge to my card no. __________________ Signature___________________