Radio Amateur Satellite Corp.
850 Sligo Ave., Suite 600
Silver Spring, MD, 20910-4703 USA
martha@amsat.org ... fax +1(301)608-3410
To: AMSAT
Please sign me up for the AMSAT President's Club. I understand that I may pay the total sum by check or VISA/MasterCard or I can choose to be charged monthly to my VISA/Mastercard as indicated below.
Name: _________________________________________ Call Sign:____________
AMSAT Member Number: ___________ (if known)
Address: ____________________________________________________________
City: __________________________ State / Province: ________
ZIP/Post code: _______________ e-mail address: ________________________
| Gold Donor: | [_] US$100 per month by VISA or MasterCard or |
| [_] US$__________ one time check or charge (at least US$1200) | |
| Silver Donor: | [_] US$50 per month by VISA or MasterCard or |
| [_] US$__________ one time check or charge (at least US$600) | |
| Bronze Donor: | [_] US$25 per month by VISA or MasterCard or |
| [_] US$__________ one time check or charge (at least US$300) | |
| Core Donor: | [_] US$10 per month by VISA or MasterCard or |
| [_] US$__________ one time check or charge (at least US$120) |
VISA or MasterCard Card Number: ______________________________ Exp. ____________
Daytime Telephone Number _____________________________ (if paying by card)
Signature: ________________________________________ Date: ___________
2002.12.12