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North Carolina Nursery & Landscape Association, Inc. Membership Application<br />
Company ______________________________________________________________________________________<br />
Corporate Mailing Address _________________________________________________________________________<br />
City _____________________________________________ State _____________ Zip _________________________<br />
Phone ______________________________________________ Fax ___________________________________________<br />
Corporate Contact _____________________________ Web Site __________________________________________<br />
Local Representative/Sales __________________________________________________________________________<br />
Mailing Address _______________________________________________<br />
County __________________________<br />
City _____________________________________________ State _____________ Zip _________________________<br />
Phone ______________________________________________ Fax ___________________________________________<br />
Email ______________________________________________________________________________________________<br />
HORTICULTURE AND LANDSCAPE RESEARCH FOUNDATION ENDOWMENT DONATION<br />
This donation is in addition to your membership dues<br />
Platinum: $200 _______ Gold: $100 _______ Silver: $50 _______ Other Amount: $ __________<br />
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SELECT ANY CATAGORIES THAT PERTAIN TO YOUR BUSINESS<br />
Wholesale Nursery<br />
Parks/Recreation/Gardens<br />
Retail Garden Center<br />
Irrigation Contractor<br />
Exterior Landscaper<br />
Allied Supplier<br />
Interiorscaper<br />
Educator<br />
Maintenance Contractor<br />
Horticulture/Landscape Student<br />
Sod/Grass Wholesaler<br />
Other ________________________<br />
Landscape Architect<br />
Membership: $150 annually Educators: $50 annually Full time horticulture students: $30 annually<br />
PAYMENT METHOD: Cash _____ Check No. ___________ VISA _____ MasterCard _____ AMEX _____<br />
Expiration Date _________________ Credit Card Number ___________________________________________________<br />
Authorized Signature _________________________________________________________________________________<br />
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Mail application with payment to: NCNLA, 968 Trinity Road, Raleigh, North Carolina 27607<br />
Fax application to: 919-816-9118<br />
Join electronically via our website at: www.ncan.com<br />
FOR INFORMATION CALL THE NCNLA OFFICE: 919-816-9119
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