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Bullet_Left.gif (207 bytes)Constituents' Page

 

Application for Membership as a

Constituent for Science and Technology Awareness

 
Name                                                                                                                 
Address                                                                                                            
City                                                                                                                     
State                                                                                                                   
Zip Code                                                                                                           
Phone Number                                                                                                

Enclosed is the $25 annual membership fee, made payable to:   
African Scientific Institute
P.O. Box 12161
Oakland, CA  94604
(510) 653-7027