Membership Request Printable Version

Date:____________________________
Name:____________________________
Title:____________________________
Employer/Firm (or Other):____________________________

Address:____________________________
City:____________________________
State:____________________________
Zip:____________________________

Phone:____________________________
Email:____________________________

Field of Interest:____________________________

Check if Address different from past record: [ ]

Membership Class:
[     ] Member $20/yr
[     ] Student $15/yr
[     ] Subscription $30/yr
Gifts are appreciated and help further the goals
and activities of NMAS $__________

Total: $__________________________
(Your Check is your reciept)

Send check payable to:
New Mexico Academy of Science
c/o New Mexico Museum of Natural History
1801 Mountain Road NW
Albuquerque, NM 87104