Membership Form

New Mexico Academy of Science

New Membership [ ]                                     Renewal [ ] (Calendar Year______)

Date: _________________

 Name: ____________________________

 Title: ______________________________

 Employer/Firm (or other):
___________________________________
___________________________________
___________________________________

 Specialities/Interests
___________________________________
___________________________________

 Mailing Address:
___________________________________
___________________________________
___________________________________

Work Phone:_______________
Home Phone:_______________
FAX: _______________
e-mail:_______________

Check if address different from past record [ ]

Membership Class (check one):
  • [ ]Member $25/year
  • [ ]Student $15/year, School____________
  • [ ]Subscription $25/year (Libraries only)
  •  [ ]Life Membership $400 (3/4 of Life Membership goes to NMAS Endowment)
  • --------------------------------------------
  • [ ]Tax Deductible Gift to NMAS Endowment $_______________
  • [ ]Tax Deductible Gift $_______________

    • Total:$____________________________
    Send check payable to "NMAS" to:
    New Mexico Academy of Science
    c/o New Mexico Museum of Natural History
    1801 Mountain Road NW
    Albuquerque, NM 87104
    Return ArrowBack to NMAS Home Page

    Last Updated, DPD, 11/14/2010