•  Cernan Earth and Space Center  

    Membership Application

    Cernan Earth and Space Center 
    Membership Application

      1. Please tell us about yourself:
      Name: 
      Address: 
      City: 
      State:    ZIP Code:
      Daytime Phone:
      Evening Phone:

        2. Please check one:

       New member 
       Renewing member 

     

        3. Please check your preferred membership:

        Mars   20 complimentary tickets per year   $   40
        Venus   25 complimentary tickets per year   $   50 
        Saturn   40 complimentary tickets per year   $   75 
        Jupiter   60 complimentary tickets per year   $ 100 

     

    I would like to contribute an additional $_________ for the continued growth of the Cernan Earth and Space Center. Contributions are tax deductible to the extent provided by law.

      4. Please check your preferred method of payment:

        Enclosed is a check made payable to Triton College for  $ 
    or
      VISA   MasterCard
      Credit Card #      Exp. Date   
      Authorization Name (please print):
      Signature:

     

        5. Please return this completed form to:

      Cernan Earth and Space Center, Triton College, 2000 Fifth Ave., River Grove, IL   60171 

      
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