Packerland Chapter of the American Meteorological Society Membership Form Print form out and complete

Name:_____________________________________  Date:___________________

Address:___________________________________

City, State:_________________________________   Zip Code:________________

Daytime Phone:_(_____)______________________

E-mail (if available):___________________________

Select Your Membership Preference:

______  $15.00  Individual
______  $5.00    College Student     Name of School, City:_________________________
______  Free     Student K-12     Name of School, City:_________________________

Are you currently a member of the Packerland Chapter?   Y     N

Are you a member of the national American Meteorological Society?   Y     N
You do not have to be a member of the AMS to be a member of a local chapter.

Are you able to assist the chapter in planning activities?   Y     N

What activities would you like to see our chapter involved in?
(Use back of sheet)

Make check or money order payable to Packerland Chapter of the AMS.

Send this form and check/money order to:

Peg Zenko, Treasurer
2494 Deckner Ave.
Green Bay, WI  54302
 

1/16/08