Membership Form

Name*

Email address*

Phone number*

Membership status*

New member

Existing member

Membership no. (if known)

Postal address on file*

Keep same address

Enter new address

Address*

Your address is used for the mailing of your Journals (street or postal address).

Street Address Town/City State / Province / Region ZIP / Postal Code Country

Membership type*

NZ single: $45

NZ double: $55

NZ corporate: $60

Australia: $60

Other overseas: $65

Total

Payment*

Heritage Roses