Lawrence Hall of Science
University of California at Berkeley
Lawrence
Hall of Science
University
of California at Berkeley
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Please enroll me as a Lawrence Hall of Science member in the following category: _______Senior $45 _______Individual $50 _______Family $75 _______Grandparents $75 Donor Memberships _______Family Plus (Best Value) $100 _______Sponsor $250 _______Associate $500 _______Partners In Science $1,000 Join with a gift of $1,000 or more and be a part of our Partners in Science. For more information, please contact the Development office at develop@uclink4.berkeley.edu |
For office
use only. MEMBER # EXP. DATE AMT. PAID RECEIPT # MAIL DATE BY |
| NAME: | |
| NAME (of second person): | |
| ADDRESS: | |
| CITY: STATE: ZIP: | |
| DAYTIME PHONE: | |
| Please list all family members: | |
| ____ Enclosed is my check made payable to The
Regents of the University of California. Total enclosed $ _______ ____Please bill my VISA, Mastercard or Discover Card (circle one): CARD # |
|
| EXP. DATE: AMOUNT $ | |
| CARDHOLDER'S NAME: | |
| Memberships are valid for one year from date of purchase and are non-refundable and not transferable. | |
| ____I would like to purchase a Gift Membership for: RECIPIENT'S NAME |
| ADDRESS |
| CITY: STATE: ZIP: |
| DAYTIME PHONE: |
| MEMBERSHIP CATEGORY: |
| AMOUNT PAID $ |
| Please list all family members: |
| Please also complete your name and address above. A gift card will be sent with your name. |
Or fax to: (510) 642-1055 (include credit card information) |