| Individual
Explorer |
Family
Expedition + Caregiver |
Nature
Adventurer |
Dinosaur
Hunter |
| Family
Expedition |
Grandparent
Adventure |
Wildlife
Watcher |
Star
Gazer |
* Please check a box for the level of membership desired, or circle the amount of fee.
Name:_________________________________________________
Address: _______________________________________________
City: ___________________ State: ______ Zip Code: __________
Telephone (H): ________________ (W):_____________________
Email:_________________________________________________
Spouse's name: __________________________________________
Number of children in residence: __________________________________
Number of grandchildren: __________________________________________
Caregiver (fill in for add-on): _________________________________
Payment Method:
Check #_________________________________________________
**Note - Checks require two weeks for processing.**
MasterCard
#_______________________________ Exp. Date: ________
VISA
#____________________________________Exp. Date: ________
Amer
Express #_____________________________Exp. Date: ________
Card holder signature: ________________________________________
Date: _______________________________________________________
| Print, complete, and mail to: Natural Science Center of Greensboro, 4301 Lawndale Drive, Greensboro, NC 27455 (336) 288-3769 ext. 311. |