The Xerces Society for Invertebrate Conservation
Membership Application

Address__________________________________________

City _____________________________________________

State _____ ZIP______________Country________________

How did you hear about us? ___________________________

Email address ______________________________________ (used only to contact you; we won't give your email to anyone)

Your membership contribution may be tax-deductible as allowable by law.

To pay by VISA or MasterCard, please also provide the following information:

Credit card number: __________________________________________

Exp. date:________ VISA or MasterCard?________

Daytime telephone (required): __________________________________

Name and billing address if different from name/address above:

Please return this form with your credit card info, or with a check or money order made payable to the Xerces Society, to:
Membership, The Xerces Society, 4828 SE Hawthorne Blvd., Portland, OR 97215-3252 USA.

Foreign members, please pay in US dollars.