GRHC MEMBERSHIP APPLICATION For a full list of all membership categories and benefits, or to apply online, please visit www.greenroofs.org/membership. Date: Name: Company: Address: City: State/Province: Postal/Zip Code: Country: Telephone: Fax: Email: MEMBERSHIP APPLICATION FOR (PLEASE CHECK ONE): ○ Supporter $55 US ○ Individual $160 US ○ Individual GRP $160 US ○ Individual Affiliate $100 US ○ Corporate (see below) ○ GRP Renewal $207.50 US IF YOU WISH TO BECOME A CORPORATE MEMBER, PLEASE CHOOSE THE MOST APPROPRIATE CATEGORY (IN US DOLLARS): ○ Charitable/Not-for-Profit ($550) ○ Green Walls ($1,250) ○ Government & Institutional ($550) ○ Distributors & Suppliers ($3,800) ○ Professionals ($550) ○ Manufacturers ($5,200) ○ Nurseries ($750) ○ Corporate Leaders($12,700) PLEASE CHOOSE THE TITLE THAT BEST DESCRIBES YOU OR YOUR ORGANIZATION: ○ Architect ○ Association Professional ○ Biologist ○ Botanist ○ General Contractor ○ Developer ○ Educator ○ Government ○ Energy Consultant ○ Engineer ○ Environmental Consultant ○ Facilities Manager ○ Horticulturalist ○ Consumer ○ Landscape Architect ○ Landscape Designer/Consultant ○ Roofing Consultant ○ Manufacturer or Supplier ○ Media ○ Not-for-profit ○ Policymaker ○ Planner ○ Researcher ○ Student ○ Water Specialist ○ Irrigation Designer ○ Sustainability Manager ○ Other ______________________________________________________ CHOOSE A PAYMENT METHOD ○ MasterCard ○ Visa Name on Credit Card: Credit Card #: Expiry Date (month/year) & 3 Digit Security Code: Signature: ○ I prefer to pay by enclosed (forthcoming) cheque payable to: Green Roofs for Healthy Cities 406 King Street East, Toronto, Ontario M5A 1L4 Canada Fax: 416-971-9844 Attention: Blaine Standhttp://www.greenroofs.org/membership