Membership Form

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Please print this form and then fill it out.

Name                                                                                                                                    

Organization/Affiliation                                                                                                            

Address                                                                          E-mail                                             

City/State/ZIP                                                                                                                        

Phone (incl. area code)                                                    Volunteer Interests                            

Amount Enclosed (donation)                                                  Circle:  New Member  or Renewal

Please send completed form with your check payable to:    

                                                            Kubota Garden Foundation
                                                            PO Box 78338
                                                            Seattle, WA  98178-0338