INTERNATIONAL HOYA ASSOCIATION

MEMBERSHIP APPLICATION FORM

YES, I WOULD LIKE TO JOIN. ENCLOSED IS MY CHECK FOR $25.00 PER YEAR

Membership and Quarterly Publication of "FRATERNA"

Outside of the United States dues are $35.00 per year payable in US funds.
Overseas mail is shipped via AIR MAIL.

We also accept Visa, MasterCard or DiscoverCard

NAME: _____________________________________________________________________

ADDRESS: __________________________________________________________________

CITY, STATE & ZIP CODE: ___________________________________________________

COUNTRY: __________________________________________________________________

E-MAIL ADDRESS: ___________________________________________________________

COMMENTS: _________________________________________________________________

___________________________________________________________________________

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Please complete upper portion of form before filling in information for Visa, MasterCard, or DiscoverCard


           Cardholder's name: ________________________________________

           Account Number: ___________________________________________

           Expiration Date: __________________________________________

           Signature: ________________________________________________

Mail this application (and payment) to:
INTERNATIONAL HOYA ASSOCIATION
ATTENTION: Membership Secretary
Jim Wayman, 4057 Carlton Avenue, Central Point, Oregon 97502