Membership Application

Membership Application

Indigenous Plants for Health Association, Inc.
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area Code Phone Number
Please indicate if you are interested in participating in any of the following study groups:

Developing indigenous plant-based products Creation of regional plant guides to bush foods and medicines Creation of a series of educational cards with traditional plant uses Developing recipes for traditional bush foods
Please tell us a little about yourself and your interests in indigenous plant foods and medicines
I agree to abide by the Constitution and any policies, rules or regulations established within the association. Signed:

Clear
Please indicate method of payment

Paypal (See below) Bank Transfer BSB 637000 Account 722660722 Personal Check Mailto: IPHA Secretary, 54 Port Road, Middle Park, QLD 4074
Should be Empty: