Photo: Kate Killerlain Morrison

Membership Sign-Up Form

This form is available for membership payment by credit card.

Instructions:

FILL IN THE FORM: Please fill in the blanks below and check the appropriate boxes. DO NOT PRESS THE RETURN key to advance to the next blank because doing so will automatically submit your information before you have a chance to complete the form. * = required fields
SUBMIT: Click the submit button and your information request form will automatically be emailed to Judy Tucker, Executive Director, The Coastal Society.
PAYMENT:Your membership application or renewal is not complete until you make payment. After you submit the membership form you will be forwarded to the TCS PayPal form which will allow you to pay by credit card.

Your Information:

* First Name:
Middle Name/Initial:
* Last Name:
* Organization:
* Mailing Address:
* City:
* State / Province:
* Country:
* Zip / Postal Code:
* Daytime Telephone #:
Fax #:
* Email:
* Present Occupation:
Primary Interests:
TCS Chapter Affiliation:
Sponsored/Referred by (put "self" if no referral):

Membership Category:

* Please select your membership category:
	Regular Annual ($70 US) - professionals/interested citizens
	New Professional Annual ($50 US) - out of school < 2 years please provide date of graduation and name of academic institution in comment box
	Retired Annual ($40 US) please provide year of retirement and former employer in comment box
	Student Annual ($20 US) - enrolled in graduate, undergraduate or secondary level academic program please provide academic advisor name and email in comment box
	Library Annual ($50 US)
	Institutional Annual ($250 US) - institution or organization list a second individual and email address in comment box
	Corporate/Agency Annual ($500) - company, business or organization please list four individuals' names and emails in comment box
	Additional Comments:

After you press "submit" you will be forwarded to our PayPal form for online credit card payment.

To submit this form, please answer the following simple math problem "captcha". This is to discourage automated scripts and bots from using this form for spam.

6 plus 24 equals: ?

Solve the above math problem and enter the solution with digits. Example: for "30 plus 10 equals ?:", enter "40".