Membership

Please complete the application below. This form will be emailed to Diane Krish. If you prefer to pay by cash or check, you will need to do so at a meeting or email Diane at krishdiane01@gmail.com to receive a blank form.

Please enable JavaScript in your browser to complete this form.

Member Information

Member Name *

First

Last

Check one of the following:

• I am joining as a new member.
• I am renewing membership.

following: Square Class

Choose from one of the dropdowns.Friend of GCMGAMaster Gardener

If Master Gardener, please list Class Year.

Primary Phone Number: *

Check one of the following:

• Check here if cell # is your primary phone.

Email *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Authorizations

Liability Waiver *

• I realize that when engaged in Gwinnett County Master Gardeners Association (GCMGA) activities, that serious physical injury and personal property damage may accidentally occur. I further realize that there is always the possibility of having an allergic reaction to or being poisoned by handling or ingesting plants and that adverse reactions may result in mild or fatal illness. Knowing the risks, I agree to assume the risks and agree to release, hold harmless, and to indemnify the GCMGA and any officer or member thereof, from any and all legal responsibility for injuries or accidents incurred by myself or my family during or as a result of any and all GCMGA activity, field trip, excursions, meeting or dining, sponsored by the Association.

Confirmation *

• Confirm Membership – $20.00

Total

$0.00

Square

Card

Name on Card

Submit

Related Images: