2010   -    5A   MEMBERSHIP   RENEWAL
1-Print,     2-Fill-Out,     3-Enclose Dues,     4-Bring To Meeting,   or  Mail To :
Tom  Whitney  -  Amherst  Astronomy  Association
1403  South  East  ST,     Amherst,  MA   01002-3031
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DATE:  ___/___/__               TOTAL  ENCLOSED  $____.___
[ ] $5 - Youth/Student/Senior    [ ] $10 - Adult    [ ] $15 - Family      [ ] $10 - Voluntary Add-On

All  Information  is  CONFIDENTIAL &  NOT  RELEASED  without  Your  Consent
[ ]  DO NOT Release My Information              [ ]  List  Me on Members Page

NAME
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Work / Other Phone #s ____________________________________________________+___________________

E-Mail ______________________________________________________________    []  Interested  in  E-Group

Club  Program  Interests _______________________________________________________________________

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