Please print and mail completed application with payment to:

Camellia Society of the Potomac Valley
Kathleen Graham
8906 Beauchamp Dr.
Alexandria, VA 22309

Your name: ______________________________________________
Address: ______________________________________________
Telephone: ___________________________
EMail: ___________________________
Amount: $__________
Annual dues are $10.00 for regular membership,
$15.00 for sustaining memberships.

Checks only, no cash or credit cards.
Make checks payable to CSPV