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
Submit
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