MID-PACIFIC BONSAI FOUNDATION

                A 501(3)(c) IRS tax-exempt non-profit foundation to exhibit, research, educate, promote, and perpetuate the art and culture of bonsai; to be the custodian of memorial bonsai in the Hawaii State Bonsai Repository, to serve as the liaison with the community, and to create international friendships through bonsai.
c/o Fuku-Bonsai Cultural Center & Hawaii State Bonsai Repository
                PO Box 6000, Kurtistown, Hawaii 96760
Email:  MPBF@fukubonsai.com
WEBSITE APPLICATION FOR MEMBERSHIP
(Please print out, fill out, and mail with check;  an online payment will be set up in the future!)
        To:     MID-PACIFIC BONSAI FOUNDATION
 
          Name:             _______________________________________________________________________________
 
          Company:       _______________________________________________________________________________
                                 (If enrolling as a Corporate Sponsor of the Fuku-Bonsai Cultural Center)
 
          Address:         ________________________________________________________________________________
 
                                    __________________________________________________________  Zip __________________
 
          Phone:           ( _____ ) ___________________
 
          Email:            ______________________________________
 
          Email:            ______________________________________    (repeat to assure clarity and correctness)
 
         ______      Please enroll an Annual Family membership as a form of support to receive email newsletters.
 
         ______      This is a new membership.
 
         ______      This is a member renewal.
 
         ______      This is a gift membership.
                                                                                                                                         Enclosed: $ _________________
 
          ______     Please enroll me in the Donor Program and send a tax-deduction receipt.
 
          ______     This is an initial donation. 
 
          ______     This adds to previous donations.
                                                                                                                                        Enclosed: $ __________________
 
          ______      Please enroll our company in the Corporate Sponsor Program with me as contact and send a tax-deduction receipt.
 
          ______      This is an initial donation.
 
          ______      This adds to previous donations.
                                                                                                                                       Enclosed: $ ___________________
 
          ______      Please contact me with more information as to how to participate as a volunteer or docent.
 
                                                                                                                        TOTAL ENCLOSED: $ ___________________
          Please enclose a check and forward to:
                              MID-PACIFIC BONSAI FOUNDATION
                              c/o Fuku-Bonsai Cultural Center
                              PO Box 6000, Kurtistown, HI 96760
 
          Please add comments, suggestions, or questions.  For assistance, please call Fuku-Bonsai at (808) 982-9880 or email:  MPBF@fukubonsai.com      MAHALO!
 
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