INTERNATIONAL PROTEA ASSOCIATION

		   APPLICATION FOR MEMBERSHIP / SUBSCRIPTION

I herewith apply for membership of the IPA  @ US$50.00 per annum.  []
Payment due on 1st January each year.
Overseas payments by credit card or bank draft (cashier's cheque).
South African payment in S.A. Rand to the equivalent of US$ at ruling
rate of exchange.
20% discount if payment is made for a two-year period.

ISHS MEMBERS may join as full IPA members by ticking above, or apply
for subscription to the Journal only (tick below), subject to
providing a copy of a valid ISHS membership card.

I herewith apply for subscription to the IPA Journal
@ US$20.00 per annum.                                              []



NAME: (please print)  ...............................................

ADDRESS: ............................................................

PHONE:  ...............................   FAX:  .....................

E-mail:  ............................................................

PAYMENT: Bank draft/cashier's cheque  []     Credit Card  []

VISA / MASTERCARD #  [][][][]  [][][][]  [][][][]  [][][][]
[][][] (CVC #)

EXPIRY DATE:  ..................  CARDHOLDER  .......................

SIGNATURE:  ..................................  DATE: ...............

Membership details:

Are you a member of your local Association?              yes [] no []

If yes, please give name and branch of the Association you belong to:

.....................................................................

Please give a short description of your activities / field of study:

.....................................................................

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Please return this form, together with a copy of your ISHS membership
card (if applying for subscription) to:

The IPA Secretariat, Private Bag X12, Botriver 7185, South Africa
or Fax ++27-28-2849777