Membership Type:	Individual Family/Couple Sernior Citizen Couple Student Affiliate Corporate Guest
Title
Initials:
First Name:
Surname:
DOB:
Gender:	Male    Female
Language:
Tel home:
Tel work:
Cell:
Postal Address:
Postal Code:
Email address:
Second card holder (Only complete when applying for family, couple or senior couple category)
Title
First Name:
Surname:
DOB:
Scholars between 6 and 18 years
Number of scholars:
Voluntary Contributions
Flora conservation:
Environmental Education:
Development Fund for Gardens:
Guest entry:
Amount:
	I hereby give Botsoc permission to debit my Visa/Master Card