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NAME AND CONTACT INFORMATION
First Name:
Middle Name:
Last Name:
Nickname:
Primary Email:
Primary Phone:	(Format: XXX-XXX-XXXX)
Alternate Email:
Alternate Phone:	(Format: XXX-XXX-XXXX)
Organization/Employer:

ADDRESSES/OTHER INFORMATION
Mailing Address
Address:
City:
State:	(select state or territory) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands
Zip:
Preferred starting address for directions to events
Street Address:
City:
State:	(select state or territory) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands
Zip:
Secondary starting address for directions to events
Street Address:
City:
State:	(select state or territory) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands
Zip:

FOR CURRENT CLUB MEMBERS ONLY
Cell Phone's Email Address for Text Messages: What's this?

Personal information display preferences on Find Members (visible to all NSN Members)
	OK to display name? Yes      No
	OK to allow contact by email? (Actual email address is not displayed) Yes      No
	OK to display primary phone number? Yes      No
Personal information display preferences on Club Roster (visible only to Club Members)
	OK to allow contact by email? Yes      No
	OK to display primary phone number? Yes      No
Notification preferences:
	Notify me of Club Event announcements by Email? Yes      No
	Notify me of Club Event cancellations by Email? Yes      No
	Notify me of Club Event cancellations by Text Message? Yes      No
	Notify me of Club Event cancellations by Phone? Yes      No
	Receive Emailed Club Newsletter? Yes      No
	Receive Emailed Night Sky Network Newsletters? Yes      No
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