Name(s) __________________________________________________________

Address __________________________________________________________

City __________________________ State _______________ Zip _____________

Phone   (H)___________________________ (W)___________________________

E-mail address ______________________________________________________

I hereby submit my application for:

_____ Regular membership(s) @ $25.00/year (or $50 for 2 years)

_____ Regular membership(s) with Astronomical League membership @ $32.50/year (or $65 for 2 years)

      _____ Additional membership(s) @ $5.00/year (or $10 for 2 years)

_____ Patron membership(s) @ $50.00/year (or $100 for 2 years)

_____ Supporting membership(s) @ $100/year (or $200 for 2 years)

_____ Corporate membership(s) @ $200/year (or $400 for 2 years)

Two-year memberships are now available! Simply check the appropriate option above and enclose your check for two years' dues.

Please enclose a check or money order for $____ made out to The Northern Virginia Astronomy Club and mail to: 
NOVAC c/o Kent Allingham, 3510 Country Hill Dr; Fairfax, VA 22030. Please allow up to 2 weeks for processing.

Signature _______________________________ Date ____________________

Optional Information:

Where did you hear of our club? ______________________________________________________________

Do you own a telescope?   [  ] yes         [  ] no

If so, what kind and size? ________________________________________________________

If not, are you considering one?  [  ] yes         [  ] no

Do you own binoculars?  [  ] yes  [  ] no  What size? __________________________________

How long have you been interested in astronomy? ____________________________________

Are other family members interested also?  [  ] yes   [  ] no

If so, what are their relation to you? ________________________________________________

How would you like to receive the club newsletter?     [  ] Paper version, mailed        [  ] Electronically via .PDF file