Connecticut Herb Association, Inc. Membership Form

Name

Business Name

Address

City, State, Zip

Phone # (include area code)

Website

E-mail

Please write a brief description to be included in the CHAI Directory of Members, including information about yourself, your relationship to herbs, your business, and reason for joining (including your focus and intentions, credentials, education, practice, etc.)  Please print clearly or type and keep to 30 words or less.

Please do not include my information in the members only on-line directory
I would like my name and mini-biography to appear in the members only on-line directory, but I would prefer that my contact information not be included
I am a Vendor and am willing to give a Member-to-Member (M2M) Discount
Please include my website in the “Member’s Websites” link:
please provide the web address
I have included $_____________ as a donation to the CHAI Scholarship Fund.
I am applying/renewing my full membership at the rate of $25.00 per year
I am applying/renewing my student membership at the rate of $10.00 per year
I do not have access to a printer and need to have materials mailed to me

Please send this information along with your annual dues (payable in June) of $25 (checks should be made out to “CHAI”) and mail to:

Connecticut Herb Association, Inc.
Membership
PO BOX 310491
NEWINGTON, CT 06131

Please note: members renewing after June will not be included in the member directory.