Member Application Membership Form New Member Renewing Member Membership Type Individual $35Joint $55Under 18 FreeSupporter $60Patron $110Benefactor $250 Name #1 First Name Name #1 Last Name Last Name Name #1 Email Email Address Name #1 Phone Name #2 (if joint member) First Name Name #2 Last Name Last Name Name #2 Email Email Address Name #2 Phone Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Are you a Full-Time Resident Part-Time Resident Months Here? (if part-time) Which best describes your orchid experience? Beginner Mid_level Knowledge Advanced Knowledge Years of orchid experience? How many orchids do you own? Are you a member of the American Orchid Society? Yes No Are you a member of other plant-related organizations? Yes No ListOrganizations How did you hear about GCOA? Do you have a special skill that you can share? Are you a photographer? web-technician? accountant? carpenter? other? Occupation (or former occupation if retired)? What type of GCOA volunteer work is best for you? Committee During Monthly Membership Events Special Events Fund Raising Teaching New Member Mentorship Hospitality Plant Judging Publicity Call me when you need me OtherOther Please check all that interest you. By entering your name below you agree to abide by the bylaws of the Gulf Coast Orchid Alliance, Inc. and give permission for photographs of yourself and/or your plants to be used by GCOA for GCOA-related purposes. Type Full Name * Date * I will pay by: * Credit Card Check Credit Card * Send check to: Gulf Coast Orchid Alliance, Inc PO Box 110263 Naples, FL 34108 If you are human, leave this field blank.