PawPaw Foundation member information form

The PawPaw Foundation
Member Information

__Mr. __Ms. __Mrs. __Miss __Dr. __Other, please specify:________________________________

Name____________________________________________________________________________________________

Address (home, work, or both)________________________________________________________________________

__________________________________________________________________________________________________

Phone (home)___________________(work)______________________(fax)____________________

E-mail address____________________________________________________________________________________

Special interests, expertise, pawpaw lore, etc. ______________________________________________________

__________________________________________________________________________________________________

Please make your check or money order (for at least $20) payable to The PawPaw Foundation, and mail it with this form to:

The PawPaw Foundation
PO Box 4483
Louisville, KY 40204

The above information is requested for our membership database. In addition, we publish a membership directory that goes out to all our members. Any information you provide may be included in the directory. If you do not want your information published in the directory, please check below:

Do not publish my ___name ___home address ___work address ___home phone ___work phone ___fax ___e-mail ___other (specify)____________________________