ALABAMA ACADEMY OF SCIENCE, INC
M E M B E R S H I P
A P P L I C A T I O N
You can also complete and pay on-line on the Academy web site:
direct link at http://www.alabamaacademyofscience.org/paydues.php
NAME:____________________________________________________________________________
ADDRESS:_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
PHONE: (Include area code)___________________________________________________________
FAX NUMBER:______________________________________________________________________
EMAIL:_____________________________________________________________________________
Please affiliate me with the following SECTION OF ACADEMY: (please encircle or check-off one of these)
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
BIOLOGICAL SCIENCE
CHEMISTRY
PHYSICS AND MATHEMATICS
ENGINEERING AND COMPUTER SCIENCE
SOCIAL SCIENCES
ANTHROPOLOGY
SCIENCE EDUCATION
INDUSTRY, ENVIRONMENTAL, AND EARTH SCIENCE
HEALTH SCIENCES
BIOETHICS & HISTORY & PHILOSOPHY OF SCIENCE
DUES I am paying with this ____application or ____renewal beginning with year 20___:
Active Member
1 year $40.00 ___
2 years $70.00 ___
3 years $100.00 ___
Student Membe
1 year $20.00 ___
2 years $40.00 ___
3 years $60.00 ___
Life Member
$300.00 ___
MAKE DUES CHECK PAYABLE TO:
ALABAMA ACADEMY OF SCIENCE
Mail to BETTINA RILEY, TREASURER AAS, 5008 8th Terrace South, Birmingham, AL 35212-4110,
triley@uab.edu.