SPACE CITY CHAPTER
AMERICAN HIBISCUS SOCIETY MEMBERSHIP FORM

PLEASE PRINT OUT A COPY - WRITE IN ALL INFORMATION - SIGN
MAIL OR PRESENT IN PERSON TO A SCC CHAPTER MEMBER WITH YOUR ANNUAL DUES
 MAKE CHECK PAYABLE TO SCC-AHS 
 MAILING ADDRESS: ►    SCC-AHS    ►  P.O. Box 7492    ►  6100 Spencer Hwy     ►   PASADENA, TX  77505

FIRST NAME:

LAST NAME:

SPOUSE FULL NAME:

MAILING ADDRESS:

CITY:

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HOME PHONE:

 ALTERNATE/CELL PHONE:

E-MAIL(S):

ARE YOU A CURRENT REGULAR MEMBER THROUGH AHS NATIONAL OR ANOTHER CHAPTER? If yes, information MUST be provided to receive discount in annual dues.  SCC-AHS ASSOCIATE MEMBERSHIP DUES ARE $15/YEAR.  Associates must be an AHS, OR another current AHS Chapter's Regular member to join at these SCC rates. Write in your affiliation and present card if in person (attach a copy if mailing) the: CURRENT AHS or OTHER AHS CHAPTER MEMBERSHIP BADGE: 

REFERRING SCC MEMBER - OR HOW DID YOU HEAR ABOUT US? 

PLEASE CHECK HOW YOU WISH TO RECEIVE YOUR GROWING PAINS NEWSLETTERS:  _____E-mail (color)  /  _____ 1st Class Mail (currently b/w)

MEMBER SIGNATURE:                                                                      

  DATE: 

INFORMATION BELOW TO BE COMPLETED BY SCC CHAPTER REPRESENTATIVE

 AMOUNT PAID:  $___________
 HOW PAID: (check applicable)
 □ CHECK:  #____________
 □ CASH:  ____________
 □ M/C-Visa
 □ M.O.
 □ CASHIERS CK

SCC INDIVIDUAL
AND FAMILY IN HOUSEHOLD
 ANNUAL DUES:

$36/YEAR

REGULAR MEMBERSHIP 

MEMBERSHIP VALID THROUGH MAY 31st 2019

'or':  ___________________________________________

 

 

RECEIVED BY SCC-AHS MEMBER: 

FEBRUARY 2018                    www.spacecityahs.org                     MEMBERSHIP FORM  2018-2019