Deep Space Exploration Society

Application for Membership

(Print and complete this form and mail it to the address below.) 

Name:________________________________________

Org:_________________________________________

Addr:________________________________________

City:_______________State:_____Zip:__________

Phone(h):____________________________________

Phone(w):____________________________________

Phone (cell):________________________________

Radio License:_______________________________

Email:_______________________________________

Skills, Interests & Affiliates:__________

_____________________________________________

_____________________________________________

_____________________________________________

Annual Membership Fee

  ___ Full Member $50 (Voting)

  ___ Associate   $20 (Non-voting)

  ___ Donation:___________________

Those making a donation of $1000 or more will 
receive a lifetime voting membership in DSES.

Donations to DSES are tax deductable.

Make checks payable to: 
  Deep Space Exploration Society

Date Paid:___________________________________

Mail application to:

  Deep Space Exploration Society
  C/O Rex Craig, President
  5921 Niwot Road
  Longmont, CO  80503