Chicago Society for Space Studies Membership Form

To become a member of the Chicago Society for Space Studies:

1. Print this page or copy the form portion into an email.
2. Fill out the form.
3. Email the form to the email address listed at the bottom. If you are making a voluntary donation, then mail the completed form along with your check to the address provided at the bottom.

Chicago Society for Space Studies Membership Form

___ Yes, I want to support the educational activities of the
    Chicago Society for Space Studies by becoming a member.

___ Yes, I am also interested in funding space education and am
    including a check payable to CSSS for construction of the CSSS
    Lunar Display. Enclosed is a check made payable to the
    Chicago Society for Space Studies in the amount of:

    $_________________________

Name:   _____________________________________________________________

Address:_____________________________________________________________

        _____________________________________________________________

City:   _______________________________________________

State:  ____________  ZIP:___________________________________________

Phone:  _____________________________________________________________

Email Address: ______________________________________________________

Please email your completed membership form to:

If sending a donation, please return this form and your check made payable to the Chicago Society for Space Studies to:

          Chicago Society for Space Studies
          8110 N. Washington
          Niles, IL  60714

Thank you for supporting the Chicago Society for Space Studies and our educational mission.