MEMBERSHIP FORM

PLEASE PRINT THIS PAGE AND MAIL OR FAX

YES, I want to become a member of the Auburn University Natural History Museum and Learning Center, and help bring the natural history of Alabama to life.

One Year Two Years

[ ] Active [ ] $40 [ ] $70

[ ] Family [ ] $60 [ ] $100

[ ] Contributing [ ] $100 [ ] $170

[ ] Naturalist [ ] $250 [ ] $450

[ ] Explorer [ ] $500 [ ] $850

[ ] Fellow [ ] $1,000 [ ] $1,700

[ ] Mr. [ ] Mrs. [ ] Mr. and Mrs. [ ] Miss [ ] Ms. [ ] Dr. [ ] Other

Name:

Address:

City:

State: Zip Code:

Home Phone: Work Phone:

I enclose a check in the amount of $
(payable to Auburn University Natural History Museum and Learning Center Foundation)

Please charge my: [ ] VISA [ ] MasterCard [ ] American Express [ ] Discover

Card Number:

Expiration Date:

Signature:

Please send completed Membership Form and payment to: AUBURN UNIVERSITY NATURAL HISTORY MUSEUM AND LEARNING CENTER-MEMBERSHIP OFFICE ??????????????, Auburn, AL 36849-????

OR FAX TO (334) 844-????

	One Year	Two Years
[ ] Active	[ ] $40	[ ] $70
[ ] Family	[ ] $60	[ ] $100
[ ] Contributing	[ ] $100	[ ] $170
[ ] Naturalist	[ ] $250	[ ] $450
[ ] Explorer	[ ] $500	[ ] $850
[ ] Fellow	[ ] $1,000	[ ] $1,700

Please charge my:	[ ] VISA	[ ] MasterCard	[ ] American Express	[ ] Discover
Card Number:
Expiration Date:
Signature: