Maintained by W-W |
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Membership Application
| Name: |
______________________________ |
| Address: |
______________________________ |
| |
______________________________ |
| |
______________________________ |
| Telephone: |
______________________________ |
| Email: |
______________________________ |
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| Credit card type |
Visa/Mastercard/American
Express/Diner's Club |
| Credit Card Number |
______________________________ |
| Expiry Date |
________ |
| Signature |
______________________________ |
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| Individual |
$25 Student
|
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| $50 Regular |
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| Family |
$100 |
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| Contributor |
$250 |
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| Associate |
$500 |
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| Sponsor |
$1,000 |
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| Patron |
$1,500 |
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Please make checks to:
UHF - Friends of the Institute for Astronomy
Your gift, less the value of membership benefits, is tax-deductible to
the extent provided by law.
Please print and mail this form to:
University of Hawaii Foundation
PO Box 11270
Honolulu HI 96828
Mahalo for your support!
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