Indiana Gourd Society
Membership Form

Mail to: Pat Moore, IGS Membership Secretary, 691 W. Veach Rd, Bloomingdale, IN 47832
Expiration date appears on address label

Two ways to complete this form:
        - Type into this form, then print it, and mail to address above
        - or print it, then print legibly or type to complete the form, and mail to the address above.
Make a copy for your records.

Select type of application:
Renewal:
New:

Select length of membership desired, prices:
$40.00 for 3 years:
$15.00 for 1 year:

Name:
Address:
City:
State:
Zip:
County:
Phone:
E-mail:
I would like electronic delivery of the Tendril newsletter (in color) instead of receiving the printed Black & White copy.
Yes             No

Society membership includes a subscription to our quarterly newsletter, The Tendril.

Make check payable to: Indiana Gourd Society