ASP: Institutional Mercury Subscription Order/Renewal Form

Äîêóìåíò âçÿò èç êýøà ïîèñêîâîé ìàøèíû. Àäðåñ îðèãèíàëüíîãî äîêóìåíòà : http://www.astrosociety.org/pubs/mercury/institutionprint.html
Äàòà èçìåíåíèÿ: Mon Jul 30 02:31:34 2012
Äàòà èíäåêñèðîâàíèÿ: Tue Oct 2 00:20:30 2012
Êîäèðîâêà:

Institutional Mercury Subscription Order/Renewal Form

Please fill out the form below and mail or fax to:

ASP
Attn: Membership
390 Ashton Avenue
San Franciso, CA 94112

Fax orders to: 415-337-5205

Subscription Type:
Subscription rate is $72 per site. ___ New Order ___ Renewal Reminder: ASP Membership benefits are not included with the new Institutional Mercury Subscriptions. If you wish to receive these benefits, you must join the ASP as an Individual or Technical Member. More information on membership. E-mail address for notification of electronic Mercury posting:_________________________________________
IP Addresses Enter your IP address(es) or range below for the subscribed site (campus or department).

Institution Information
ASP Account Number	_____________________________________________________
Institution Name	_____________________________________________________
Institution Mailing Address	_____________________________________________________
Address 2	_____________________________________________________
City	_____________________________________________________
State	________
Zip	_____________________________________________________
Country	_____________________________________________________
Contact Information
Contact First Name	_____________________________________________________
Contact Last Name	_____________________________________________________
Business Phone	_____________________________________________________
E-mail	_____________________________________________________
Billing Information - Please select one method of payment
Purchase Order # or Reference #	_____________________________________________________
Payment by check	Please make checks payable to ASP.
Credit Card Type	___ Visa ___ MasterCard ___ Discover
Credit Card Number	_____________________________________________________
Expiration Date (MM/YY)	_____________________________________________________
Help us get to know you
How would you categorize your Institution?	___ University Library ___ Public Library ___ Observatory/Planetarium ___ Museum ___ Other ___________________________________________________
___ Occasionally, we exchange our membership list with organizations whose products or services we believe may be of interest to our members. If you prefer that we do not share your name, please check this box.

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