Membership form

First Name:

E-Mail:

Total amount enclosed or to be charged is:

Protection Code:

Please, enter the CASE SENSITIVE text shown in the image into the field below.

BCI Membership Application Form

If you wish, you may use this form to apply for membership.
Complete it and then print it out and MAIL it with payment,
or FAX it with your credit card information.

Last Name:

Address:

City:

State:

Country:

Membership Type:

New or Renewal?

If Renewal, give 6 digit BCI Membership Number:

Name of your local club, if any:

Where you first heard about BCI?:

Mail your application and payment in US funds, payable to Bonsai Clubs International, to:

Bonsai Clubs International
P.O. Box 411893
Melbourne, FL 32941-1893, USA

or

Fax your application and credit card information to BCI at:

(321)-259-0832

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