BUTTERFLY SOCIETY OF VIRGINIA, INC. MEMBERSHIP FORM

(Indicate Woodpecker Ridge Chapter if applicable)

Names(s) ________________________________________________

Address_________________________________________________

             _________________________________________________

Phone  (W) _______________________(H)______________________

Present, or if retired, former occupation_____________________________

Membership is $15 for 12 months.  Second member at same address, $7.50.  

       Student, 21 and under $7.50.  

Mail with check made out to the Butterfly Society of Virginia to: Membership Chairman

        5052 Clairmont Ct., Virginia Beach, VA 23462.  

You can use this form with the membership chairman's address outside,

       ends and bottom taped.

For further information: (757) 456-0440.

                                                                              Membership Chairman

                                                                             The Butterfly Society of Virginia, Inc.

                                                                              5052 Clairmont Ct.

                                                                             Virginia Beach, VA 23462