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APPLICATION
we would like to become a Corporate Affiliate of the ASP for one year. Enclosed with our application is our check for the following level of support: m m m m $2,500 $5,000 $10,000 $25,000 $4,999 $9,999 - $24,999 and up Contributing Affiliate Supporting Affiliate Sustaining Afffiliate Partner Affiliate

YES,

NAME

APPLICATION DATE

TITLE

COMPANY NAME

STREET ADDRESS

CITY

STATE, ZIP

E-MAIL ADDRESS

TELEPHONE PLEASE DESCRIBE YOUR COMPANY (100 WORDS OR LESS)

FAX

Thank you! Please send application form and contribution to: Corporate Affiliate Program Astronomical Society of the Pacific 390 Ashton Avenue San Francisco, CA 94112 Telephone: 415-337-1100 Fax: 415-337-5205 Email: corporateaffiliate@astrosociety.org Membership amount _________ Check enclosed Invoice Requested Other (please attach agreement)

Please email a jpeg of your corporate logo (72dpi) and website link to: corporateaffiliate@astrosociety.org
Office Use Only. Start Date _____________