Please print out this page, fill in the number of memberships for any particular type, and mail it to the address below with your payment.
United States:
___ Pre-Support ($20.00 Each)
___ Pre-Oppose ($40.00 Each)
___ Pre-Dither ($60.00 Each)
___ Friend of the Bid / Fellow of the Academy ($75.00 Each)
Canada:
___ Pre-Support ($30.00 Each)
___ Pre-Oppose ($61.00 Each)
___ Pre-Dither ($91.00 Each)
___ Friend of the Bid / Fellow of the Academy ($115.00 Each)
Any and all other countries: payment accepted in US or Canadian funds only!
Name(s):_______________________________________________________
Address:_______________________________________________________
City:_________________________
State/Province:_____________________
Zip/Postcode:___________________________________________________
Country:_______________________________________________________
EMail:_________________________________________________________
Privacy notice: This information may be held on a computer. Los Angeles in 2006 does not sell our mailing lists or share them with other groups outside of SCIFI, Inc. except where required by the WSFS Constitution. We may list some member information (name, member number, city, state/province and country) in our publications and on our website.
IF YOU DO NOT WANT YOUR NAME LISTED ON THE WEBSITE OR IN THE PUBLICATIONS, please initial here: ________ and date: _______________
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