New York Paleontological Society Website Application

Make check or money order payable to the

New York Paleontological Society
and send to P.O. Box 287
  Planetarium Station
  127 West 83rd Street
  New York, NY 10024

PLEASE DETACH AND RETURN WITH YOUR DUES

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WEBSITE APPLICATION

MEMBERSHIP YEAR Sept 2016 - Aug 2017 Today's Date_________________

Please check one: _____New Member _____Renewal

Name_______________________________________________ Phone ( )_____________

E-mail_____________________@_____________________

Street__________________________________________________________Apt.__________

City_____________________________________ State________________ZIP____________

Membership Category: _____Individual ($15.00) Amount Enclosed$_______________

_____Family ($20.00)

How did you first learn about the society?_____________________________________________

Do you have any expertise in paleontology or geology?___________________________________

_____________________________________________________________________________

May we contact you to help with volunteer committee work?________________________________

Affiliations to other societies or groups (if any)__________________________________________

Please list interests (especially in paleontology or related fields):____________________________

_____________________________________________________________________________

_____________________________________________________________________________

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