SIGN UP NOW TO BECOME AN ACTIVE MEMBER OR SPONSOR We will contact you for payment information, or you may include it by fax or mail. (Please print this page to fax or mail form.)
Mrs. Ms. Mr. Other
Name:
Address:
City:
State:
Zip:
Phone - Home:
Phone - Business:
E-mail Address:
Preference for being contacted:
Home Business
Membership Level:
-- Select Membership -- Individual - $40 Student - $20 Senior - $35 Sea Slug Individual - $35 Dual/Family - $60 Senior Family - $50 Sea Slug Family - $50 Discoverer's Circle - $100 Explorer's Circle - $250 Researcher's Circle - $500 Chancellor's Circle - $1000 Director's Circle - $1,200 + Sponsors
Method of Payment:
VISA MC Check
Total Amount:
Do you wish to receive your benefits?
Yes No
Would you like information about:
Business or individual sponsorships Gifts Endowments Planned Giving Memorial Bench Facility Rental
•If sending by fax or mail please include: credit card number: __________________________ exp. ___/___ signature: ____________________________________________
OR:
•If sending by mail please include check made to Friends of Long Marine Lab
MAILING ADDRESS:
Friends of Long Marine Lab 100 Shaffer Road, Santa Cruz, CA 95060 Fax: (831) 459-1221 Membership: (831) 459-4568 General Info: (831) 459-3800
