ARIZONA-NEVADA ACADEMY OF SCIENCE
                       MEMBERSHIP DUES FORM    

Name:_____________________________________________________________________________

Address:__________________________________________________________________________

     _____________________________________________________________________________

City: _______________________________________________________

State:________________________ Zip:__________________ (Include 4-number extension)

Affiliated Institution: ____________________________________

Telephone: _____________________________________________ (Please verify area code)

e-mail:_____________________________________________________
 
                                                      Area of Interest
Membership Rates (mark one)                           (mark one or more)
Regular $35.00                                          Anthropology
Family $45.00                                           Biology
Fellows $35.00                                          Chemistry
Students* $15.00                                        Conservation
Sustaining $150.00 (or more)                            Geography
Patron (Business or Institution)  $100.00               Geology
Life $700.00                                            Hydrology
                                                        Science Education

In order to reduce costs, ANAS now provides the Newsletter and the Membership 
Directory online rather than mail paper copies to its members, and members 
providing email addresses will receive the Newsletter online plus messages 
from the ANAS listserve. JANAS, the ANAS Journal, is now published online and 
is available free-of-charge to most members through their affiliated institutions.
Please mark your preferences below. 
  Check here if you DO NOT want your address listed online|_|
  Check here if you DO NOT want receive the Newsletter by email |_|
  Check here if you WANT TO RECEIVE A PAPER COPY of the JOURNAL |_| $10.00
 
                                                TOTAL PAYMENT $_____
 
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*Student members, please include a copy of your student ID or a signed statement 
from your advisor, attesting to your student status. 

Make Checks Payable to: Arizona-Nevada Academy of Science

Print out this membership form, fill it in, and send it with payment To:
         Ingrid Novodvorsky
         Department of Physics 1118 E. 4th St.
         University of Arizona
         Tucson, AZ 85721
         (520) 626-4187
         Email: novod@physics.arizona.edu