NAME__________________________________________________________

ADDRESS_______________________________________________________

CITY____________________________________STATE_______ZIP_______

PHONE_________________________________________________________

EMAIL__________________________________________________________

Enclosed please find check or money order:  $10.00 (family) annual____$125 life_____
enrolling me in the Ohio Mushroom Society.  My interests are:

Mushroom eating/cookery______Photography_______Nature study______
Mushroom ID______Other (specify)_______________________________
Would you like to be an OMS volunteer?_____In what way?____________

SIGNATURE_________________________________________________

Return form and money to:  Ohio Mushroom Society c/o Dick Doyle, 14 Sunset Hill, Granville, OH  43023-1162