Family/Dual Member Signup

Date:	5/15/2008
Member Name:
Address:
City:	State: Zip:
Email Address:
Phone Number:
Membership Type:	Science Station Membership $60 - Admission for two adults and all children or grandchildren under the age of 18. Science Station Dual Membership $45 - Can be shared by two people or used by one person with one guest pass each visit.
Senior Discount:	I am a Senior Citizen over the age of 62 ($5.00 discount)
Donation:	I would like to make an additional donation of $ to the Science Station fund raising efforts.

* All credit card transactions are subject to a 3% handling surcharge charge.