The American Elasmobranch Society

Membership

Membership Renewal

RENEWAL DEADLINES:
January 1 to be considered a MEMBER IN GOOD STANDING
March 1 to be considered an ACTIVE MEMBER

Category: (check renewal category) _____Standard _____Affiliate
Membership Level: (check one)

___ Student ($25.00)
___ Regular ($50.00)
___ Family ($60.00)
___ Foreign ($40.00)
___ Associate ($100.00)
___ Sponsor ($250.00)
___ Patron ($500.00)
___ Lifetime ($1,000.00)                                                                                                 ___ Benefactor ($1,000.00)
___ Corporate ($5,000.00)

Total Enclosed $ ______________

* All funds must be in U.S. currency, drawn on a U.S. bank or a New York bank draft, (payable to American Elasmobranch Society), or complete credit card information below.

We accept MASTERCARD or VISA

   NAME AS IT APPEARS ON CARD: ___________________________________

   CREDIT CARD NUMBER: _________________________________________

  EXP DATE:_____________________________________________________

   THREE DIGIT CODE (ON BACK OF CARD): ___________________________

   SIGNATURE: ______________________________________________________

   CIRCLE ONE:     MASTERCARD       VISA

   PLEASE PRINT CLEARLY

   Title_____ First Name___________ Last Name _____________________________

   Affiliation: _________________________________________________________

   Mailing Address: _____________________________________________________

   ___________________________________________________________________

   City _____________________________ State _________________ Zip_________

   Country_____________________________________________________________

   Telephone No.____________________ FAX No. ___________________________

   E- Mail Address:______________________________________________________

   Web Page URL ______________________________________________________
                                                                                                                                                                                                                           Degree Program (for student renewals, e.g. M.S. in Biology): ______________________

The AES newsletter and membership directory will be posted on the AES website.

Print a copy of this form and forward to AES Treasurer, Daniel S. Ha:

Daniel S. Ha, AES Treasurer
1058 Cobblestone Lane
Lancaster, PA  17601-3368 USA
Phone: 717-569-1061
E-mail: dshaxx@verizon.net