INTERNATIONAL LILAC SOCIETY
INITIAL MEMBERSHIP APPLICATION OR RENEWAL
NAME___________________________________________________________________________________________________________________
ADDITIONAL FAMILY MEMBER NAMES____________________________________________________________________________
COMPANY OR INSTITUTION (commercial/institutional membership) Attach a brief description of your company/institution for our directory.
__________________________________________________________________________________________________________________________
MAILING ADDRESS___________________________________________________________________________________________________
May we publish your address as a member in the LILAC Journal? Yes No
EMAIL ___________________________________________________________________
May we publish your email as a member in the LILAC Journal? Yes No
PHONE NUMBER________________________________________________________
May we publish your phone number as a member in the LILAC Journal? Yes No
FOR WHICH MEMBERSHIP APPLICATION ARE YOU APPLYING? (circle one)
SINGLE/FAMILY $20 US
SUSTAINING $30 US
COMMERCIAL/INSTITUTION $50 US
LIFE MEMBER $500 US
My check is
enclosed
Charge my credit card: (Visa and Mastercard only)
Type of card: Visa Mastercard
Card Number: ________________________________________Card Expiration Date___________________________
Signature of Card Holder___________________________________________________________
SEND ALL APPLICATIONS
TO: WILLIAM TSCHUMI, TO PRINT, CLICK “PRINT” ON YOUR BROWSER
ILS ASST TREASURER