Membership Form

for New or Former members

Image Credit: "Aristarchus City" by

Bill Wright (www.imagekind.com)

Thank you for your interest in joining NSS! Your membership with participation and/or financial support will
allow us to work with U.S. and world leaders, and their citizens, to ensure adequate policies and funding for
human spaceflight, exploration, and development. Use this form to join NSS via check or credit card. Former
NSS members whose membership has lapsed over 9 months can also use this form. A letter of acknowledgment
or Join NSS online via: www.nss.org/join
will be mailed to you after this form is processed.

First/Given Name________________________ Last/Family Name____________________________

Email Address_____________________________________________________________________
Street Address _____________________________________________________________________
_________________________________________________________________________________
City____________________________ State_________________ Postal Code_________________
Country____________________________________ Phone Number________________________
[ ] Former Member (lapsed > 9 mo) rejoining

Member Number (if known) ______________

Other Membership Options

Membership Choice (check one)

[ ] US $ 20 One-year Introductory

[ ] Have my local chapter (if any) contact me.

[ ] US $ 75 Contributor membership

[ ] Sign me up for the Political Action Network

Payment Method (check one): [ ] Check enclosed, [ ] Credit Card (or Debit Card) see below
Credit/Debit Card information
Credit Card Type (check one): [ ] VISA, [ ] MasterCard, [ ] AMEX, [ ] Discover
Card Number: ___________________________________

Expiration: Month____ / Year _______

Cardholders Name: _______________________________________________________

U.S. taxpayers: The portion of Membership Dues above $12.50 can be considered a donation for tax purposes.

Send this form via postal mail to:

National Space Society
P.O. Box 98106
Washington, DC 20090-8106

Or Fax this form to:

Fax: (703) 435-4390
Phone: (202) 429-1600
Email: membershipNSS.org

For NSS Internal Use:

Chapter/Recruiter Code: ______________
Event Code: ________________________