Membership Application Form

Send this form to:  International Hemp Association, Postbus 75007, 1070 AA Amsterdam, the Netherlands.  Please enclose the annual fee, preferably as an International Postal Money Order or an American Express or Thomas Cook Money Order.  1994 membership fees, student: US$ 25, individual: US$ 50, sustaining: US$ 100 or more.   (PLEASE PRINT)

Name/Organisation _______________________________________________________
Street address         _______________________________________________________
City ____________________ State/Province __________________________________
Postal code ______________ Country _______________________________________
Tel ____________________ fax __________________ e-mail ____________________

Membership:        O Student         O Individual         O Sustaining

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?        O Yes         O No

Date _________________ Signature