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					                            MEMBERSHIP APPLICATION
                                Please enroll me as a member of the
                                     Entomological Society of
                                           Pennsylvania

Name      _______________________________________________________

Address _______________________________________________________

          _______________________________________________________

Phone    ______________________                       FAX _________________________

E-mail   ____________________________

                                          Membership Category

Regular member $8.00 _____

Student member $5.00 _____

               (Membership applications received after October 1 will be applied to the following year.)


                               Please send complete application and
                                check payable to the Entomological
                                    Society of Pennsylvania to:

                                  Dan Bogar, Treasurer
                            Entomological Society of Pennsylvania
                                 421 Susquehanna Street
                                   Marysville, PA 17053




                              MEMBERSHIP QUESTIONNAIRE

Please provide the following information to help us keep our membership directory up to
date.

What is your area of entomological interest? (e.g. agriculture, aquatics, collecting, forest
pests, medical entomology, pest control, rearing, teaching, beekeeping, etc.)
What insect/arthropod groups pique your interest?




Do you maintain a personal collection? If contacted, would you be willing to help
members with questions or identifications?




Are you interested in entomology as a profession, a hobby, or both?

				
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