National Space Society Membership Form

 

Participate in helping further our future in space! Become a member of the National Space Society and a member of the Clear Lake Area chapter. Chapter membership is free to all national members, but to be listed as a chapter member, you must join the local email list.

 

___ $20 senior/student

___ $35 individual

___ $45 library gift subscription (include library information or let us choose one)

___ donation to chapter project (specify project or let us choose one)

___ $50 contributor (includes NSS membership)

___ $100 pathfinder (includes NSS membership)

___ $250 explorer (includes NSS membership)

___ $500 pioneer (includes NSS membership)

___ $1000+ visionary (your name will be listed in Ad Astra)

 

$_______ TOTAL

 

Name     ___________________________________________

Address ___________________________________________

City, State and Zip Code    _____________________________

Phone   _____________________

Fax      _____________________

E-Mail address: __________________________

Alternate address _________________________

Library Name _______________________________________

Library Address _____________________________________

City, State and Zip Code ______________________________

Do you want to receive the monthly NSS Online Report? ___ yes  ___ no

Do you want to receive chapter meeting notices? ___ yes  ___ no

 

Check enclosed _____ or

Please bill my ___ Visa ___ MasterCard

 

Card number ____________________________

Expiration date _____________

Signature (required for credit cards) ____________________________

 

Your contribution, except $10 that pays for a subscription to Ad Astra, is tax-deductible to the extent allowed by law.

 

Print out this form, enclose payment, and mail to:

 

Clear Lake Area NSS

15443 Runswick Dr.

Houston, TX 77062-3310

 

To prevent any delay in processing your membership contribution, please send e-mail to [email protected] and tell us the date it was mailed. (We can also then add your email to our local space event announcement list.)

 

Note, you may join NSS online through the National web site: http://www.nss.org. If you select the Clear Lake Area/Houston chapter, part of your dues will go to the chapter to support local projects. (It will not cost you anything extra!)

 

Thank you!

 

Form last updated: 1-09-08