Fort Worth Bonsai Society 2022 Membership Form Please submit at a club meeting or mail to: Fort Worth Bonsai Society c/o Mark Bynum, Treasurer 2708 Chinquapin Oak Lane Arlington, TX 76012 Date: _________________ Name: _______________________________________________________________ Address: _____________________________________________________________ City: _______________________ State: ________________ Zip Code: ___________ Telephone:     Hm __________________________ Cell ________________________ E-mail Address: (for Newsletter & Notices) _____________________________________ Please ckeck your membership selection below: ___    Individual Membership:$25.00 ___    Joint Membership:$35.00             (Partner's name: ___________________________________________________) ___    Student Membership:$15.00 For Treasurer's Use Only: Name:    _________________________________ Membership Year:    2022 Amount Paid:    ___________________________ Date:   _______________ Dues Received By:   ____________________________________