Membership Form (Print and Return)

Fellows of the American Geographical Society play an important role in helping our programs succeed. Your membership as a Fellow will help underwrite Society initiatives in scientific research, exploration, and education.

Full Name _______________________________________________________

Mailing Address ___________________________________________________

City _______________________ State ___________ Zip Code _____________

Daytime phone ____________________ Evening phone ___________________

Fax ___________________ E-mail address ___________________

Annual Dues (2010) for Fellows: $65.00 ______ (Check here)

Annual Dues (2010) for Institutions: $85.00 _______ (check here)

Please indicate the amount of your additional contribution below:

__ $25  __ $50 __ $100 __ Other _______ (Check one for additional contribution)

Method of payment:

__ My check is enclosed, payable to the American Geographical Society.

__ Please charge my credit card:

__ Visa __ MasterCard __ American Express

Acct. Number _______________________ Exp. _________

Signature ________________________________________

Tax-deductibility: The American Geographical Society is recognized as a tax-exempt, nonprofit organization under section 501(c)(3) of the Internal Revenue Code. Contributions to AGS are tax-deductible within the limits of the law.

Whether you give by check or credit card, the AGS will send you a printed acknowlegement for tax purposes.