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 call (310) 548-6279 
ACS logo (whale tail)   AMERICAN CETACEAN SOCIETY
membership application

(1) NAME:

name: ______________________________________
address: ______________________________________
city: ______________________________________
state: _________________ zip:_______________
country: ______________________________________
phone: ______________________________________
email: ______________________________________
notes: ______________________________________
______________________________________
______________________________________
CHECK AS MANY OF THE
FOLLOWING AS YOU WISH:
____ Add my email address to the ACS Action Alert! list *
____ Send me trip & special event notices via email *
* ACS ACTION ALERTS!, TRIP NOTICES,
& SPECIAL EVENTS NORMALLY ONLY OCCUR
A FEW TIMES PER YEAR

(5) METHOD OF PAYMENT

___ check / money order enclosed (make payable to ACS; US dollars only)

___ Visa ___ Mastercard
___ American Express ___ Discover
Card #: ___________________
Expiration date: ___/___
Billing address if different than shipping address:
_________________________________________
_________________________________________
_________________________________________
Signature: _____________________

(2) NEW OR RENEWAL?

______ new membership
______ renewal

(3) TYPE OF MEMBERSHIP, DUES:

____ $750 Lifetime*
____ $500 Patron*
____ $250 Contributing*     
____ $75 Supporting*
* Special gift in Premium Categories

____ Please do not send a Premium gift-
use all of my dues to save the whales!
---
____ $45 Foreign (Credit Card or US funds only)
____ $45 Family (EXTENDS PRIVILEGES TO EVERYONE IN HOUSEHOLD)
____ $35 Active
____ $25 Senior
____ $25 Teacher (EXTENDS PRIVILEGES TO STUDENTS IN CLASSROOM)
____ $25 Student
---
$__________  Additional Donation

(4) CHAPTER AFFILIATION:
IF LEFT BLANK AND IT ISN'T OBVIOUS WHICH CHAPTER YOU ARE CLOSEST TO, YOU WILL BE PLACED IN THE 'AT-LARGE' CATEGORY. NEW AT-LARGE MEMBERS: WE ENCOURAGE YOU TO PLEASE CONTACT THE NATIONAL BOARD FOR SUBCOMMITTEE ASSIGNMENT OPPORTUNITIES.

____ At-Large
____ Puget Sound
____ San Francisco
____ Monterey
____ Channel Islands
____ Los Angeles
____ Orange County

ACS is a 501(c)(3) public benefit corporation.
Your annual membership dues as well as your donations are tax deductible to the extent permitted by law.
Please consult your CPA for details.

Please check with your employer about their Matching Gift Programs.


Application Options and Instructions:

MAIL PHONE

* We recommend using Print Preview before printing this form.

* If necessary, you can modify your print preferences to make the membership application fit on one page. For Internet Explorer, reduce the default top and bottom margin size. For FireFox, use the 'shrink to fit' option.

* Regardless of browser, these instructions will overflow onto a second page, but you don't need to print the second pagef you want to minimize paper useage.

* mail completed form to:

    ACS - Membership
    P.O. Box 1391
    San Pedro, CA 90733-1391

* include either a check, cashier's check, money order, or credit card info

 call (310) 548-7821
note:

memberships ordered via US mail with an enclosed check, money order, or cashier's check are the most appreciated because they minimize staff time and we have to pay a fee for credit card orders

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UNLESS YOU DID NOT REACH THIS PAGE FROM www.ACSonline.org.

rev 5/04