LRS-NSS Membership Form

Lunar Reclamation Society Membership Form
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 Lunar Reclamation Society chapter serving SE Wisconsin.

Lunar Reclamation Society Memberships (include one year subscription to Moon Miners' Manifesto)

___ $18 LRS chapter dues (NSS membership optional)

___ $12 LRS chapter dues (students & seniors)

NOTE: Original first time new membership in NSS, if mailed in through LRS, includes first year free membership in LRS. Renewals to both organizations are handled separately.

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

National Space Society Memberships

___ $20 NSS dues (students & seniors)
___ $38 NSS dues individual

Ad Astra Library Subscriptions

___ $38 library gift subscription (include library information or let us choose one)

National Space Society Special Memberships

___ $50 contributor (includes NSS membership)
___ $100 pathfinder (includes NSS membership)

___ $250 explorer (includes NSS membership)

___ $500 pioneer (includes NSS membership)

___ $1000+ visionary (includes NSS membership)
...............(your name will be listed in Ad Astra)

$_______ TOTAL

Contact Information (* required fields)

PRINT NAME

*

Street Address

*

2nd address/Suite#/Apt#

City, State, Zip Code

*

Work Phone

Home Phone

Cell Phone

Best time to call

Fax

Email

For Library subscriptions

Library Name

Library Address

City, State, Zip Code

Yes No
Optional Information 1

Do you want to receive the monthly NSS Online Report?

Do you want to receive chapter meeting | event notices?

Optional Information 2 - Tell us about any talents or abilities you have that you think might be helpful for chapter activities and projects.

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Payment Information

Check or money order enclosed [...] make payable to "Lunar Reclamation Society, NSS"

Please bill my [...] Visa [...] MasterCard

Card number ____________________________

Expiration date (mm|yy) ______|______

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:

Lunar Reclamation Society NSS
PO Box 2102

Milwaukee, WI 53201

To prevent any delay in processing your membership contribution, please send e-mail to kokhmmm@aol.com and tell us the date it was mailed. Otherwise, your payment could possibly remain at the PO Box until the next monthly officers’ meeting, delaying the start of your newsletter (and/or Ad Astra) subscription.

Note, you may join NSS online through the National web site: http://www.nss.org. However, the chapter will not receive any rebate or notice of your joining. If you choose to do so, and wish to join in chapter activities, you will need to contact us, or simply come to one of our meetings. Meeting schedule: http://www.lunar-reclamation.org

Thank you!

Form last updated: 10-27-02

	Contact Information (* required fields)
PRINT NAME	*
Street Address	*
2nd address/Suite#/Apt#
City, State, Zip Code	*
Work Phone
Home Phone
Cell Phone
Best time to call
Fax
Email

	For Library subscriptions
Library Name
Library Address
City, State, Zip Code

Yes	No	Optional Information 1
		Do you want to receive the monthly NSS Online Report?
		Do you want to receive chapter meeting \| event notices?