IMPORTANT: Please do NOT use this form if you wish to pay membership dues using PayPal via our website at: www.americanprimrosesociety.org. Note that PayPal is the least expensive, most convenient and most secure method of payment for both you and the society. Please complete this form for all other methods of payment.

 NAME: _______________________________________________________________

 STREET ADDRESS: ____________________________________________________

 CITY: _______________________ STATE/ PROV/COUNTRY: __________________

 ZIP/Post Code: ________

 EMAIL: _____________________________ PHONE: __________________________

 Membership rates vary as follows. Please check the one that applies:

 ___ Annual Membership, US and Canada: US$25

___ Three years membership, US and Canada: US$70

___ Annual International Membership: US$32

___ Three years International Membership: US$90

___ Sustaining Membership: US$100 per year (or any amount over $100)

___ Gift Membership US$25 per year (a card with your name will be sent)

___ Holiday Gift US$25 per year (a holiday card with your name will be sent by Dec 15)

___ Donation US$__________

Method of Payment (Please check one):

 ___Money order (payable to The American Primrose Society)

 ___ Check (payable to The American Primrose Society)

Send this form to the address below. Receipts will not be sent unless requested (S.A.E. please). Payment must be in US dollars.

American Primrose Society

Jon Kawaguchi, Treasurer

3524 Bowman Ct.

Alameda, Calif. 94502

 Tick here if you do not want your name to be printed in our Annual Membership list: ___