2 0 0 8   -    5A    M E M B E R S H I P      A P P L I C A T I O N 
Tom  Whitney  (413) 256-6234,  Mon - Thr  Eve., After 6 PM         E-MAIL

1- Print      2- Fill-Out        3- Bring To Meeting/Event  or  Mail With Dues To :
Amherst  Astronomy  Association,   1403 South East ST,    Amherst, MA  01002-3031

DATE: ____ / _____ / 08                    AMOUNT  ENCLOSED:  $ _____. ____
[]-$5 Youth/Student/Senior        []-$10 Adult       []-$15 Family       []- $10 Voluntary Add-On

NAME____________________________________________________________________________

If Family,  List Members_____________________________________________________________

Street  Address____________________________________________________________________

Town_________________________________________    State______    Zip __________________

Phone >  Home : (_____) ________-_____________           Work : (_____) _______-____________

Other/Cell  Phone #s _______________________________________________________________

Best Time to Call__________________________________________________________________

E-Mail___________________________________________________________________________

Occupation_______________________________________________________________________
Interests :
[ ]-Club Programs    [ ]-Public Programs    [ ]-Observing    [ ]-Dark-Sky     [ ]-Sun    [ ]-Moon
   [ ]-Planets    [ ]-Computers/Internet    [ ]-Imaging    [ ]-Physics     [ ]-Speaking
   [ ]-Other:  ______________________________________________________________________
All  Information  is  Confidential  &  Not  Released  without  Your  Consent
[ ]- List Me On Members Page