Scripps Oceanographic Society

Please print and mail this completed form to:

Scripps Oceanographic Society
Scripps Institution of Oceanography
Development Office, Department 0207
9500 Gilman Drive
La Jolla, California 92093-0207

Name:        ___________________________________________________

2nd Adult:   ___________________________________________________

Address:     ___________________________________________________

City/St/Zip: ___________________________________________________

Phone:       ____________________________ 

FAX:         ____________________________            E-mail Address: ___________________________	

Number of children under 18          _______		Number of grandchildren under 18  _______ 

Enclosed is $________________ for membership in (see membership levels chart for specific costs and benefits):

[   ] E. W. Scripps Associates	  [   ] Expedition Team         [   ]  Discovery Team   [   ]  Voyager Team

[   ] Supporting	                  [   ] Family/Grandparents   [   ] Dual                     [   ] Individual 

[   ]   I would like my membership to be fully tax deductible.  I do not wish to receive aquarium benefits.

[   ]   I am eligible for a $5 discount on individual and dual memberships because I am  
		[   ] a full-time student    [   ] a senior (over age 60).

[   ]  Enclosed is a tax-deductible contribution of $__________________________.

[   ]  Please bill my Society membership/contribution of $ _______________ to my 	[   ] VISA   [   ] Mastercard
			   
        #   _______________________________    Exp.  Date:_____________

          
        Signature: ______________________________________                                                                                                                                                                        


*Please make checks payable to:  UC Regents

Information regarding your gift will not be released except as required by State and Federal law. One way we express our thanks to our donors
is to recognize them in publications. Should you wish that your name not appear as a donor, please notify us in writing. 

Scripps Institution of Oceanography is a division of the University of California, a non-profit, educational institution. Under Internal Revenue Service
guidelines some or all of your membership contribution may be tax deductible.  Please review the membership levels chart to determine your eligibility
for a deduction.  Any gifts and restrictive terms and conditions are subject to University acceptance. All gifts will be acknowledged upon acceptance.
A modest fee is assessed on gifts to support University administrative costs.

Scripps Institution of Oceanography
University of California, San Diego
development@sio.ucsd.edu

This page last edited 04/4/98