Membership Application

Name *

First

Last *

Last

Street Address *

City *

State

Zip Code *

Phone

xxx-xxx-xxxx

Fax

xxx-xxx-xxxx

Cell

xxx-xxx-xxxx

Email *

The address to which correspondence should be sent

Badge Name

Name as it should appear on badge

Business Address?

Yes

Business Name

Business Street Address

Business City

Business State

Business Zip

Business Phone

xxx-xxx-xxxx

Business Fax

xxx-xxx-xxxx

Business Cell

xxx-xxx-xxxx

Employment Status

Retired

Semi-Retired

Employed

Other

Nickname

Spouse

Sponsor Name

Sponsor Email

Birthday

Month & Day (i.e. Dec 12)

Year

Birth Year

Member of National Garden Clubs?

Yes

If Yes, Where?

Member of Garden Clubs of America?

Yes

If Yes, Where?

Master Gardener?

Yes

If Yes, Where?

Flower Show Judge?

Yes

If Yes, Level/Good Standing Date

Summer Information

Summer Res. Dates

(i.e. June-Sept)

Summer Street Address

Summer City

Summer State

Summer Zip

Summer Phone

xxx-xxx-xxxx

Summer Fax

xxx-xxx-xxxx

Summer Cell

xxx-xxx-xxxx

Background

Educational History

Include degrees and dates, most recent first

Career History

Include company/organization, dates, title/responsibilities, most recent first.

Local (Collier/Lee Counties) Civic and Community Organizations

Include name of organization, position and/or responsibilities, whether
current or past and whether or not you served on the board.

Other Civic and Community Organizations

Include name of organization, position and/or responsibilities, whether
current or past and whether or not you served on the board.

Please acknowledge your understanding by checking the
box for each of the following statements. *

I understand that to become an Active Member I must complete
the Provisional Requirements

I understand that most NGC communications are electronic and
I am required to be able to use e-mail and the Internet.

If selected, I understand that my participation in the Provisional
Program involves a commitment of time and energy. Upon becoming
an Active Member, I agree to use the acquired knowledge and
relationships developed in the Provisional Program to support
The Club’s mission and to meet the obligations of Active membership.

S	M	T	W	T	F	S
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	31

Summer Information

Skills and Experience

Garden Club and Related Experience

Background

NGC Event Calendar

Garden Friend Events

Links

Contact