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						Please complete this form to apply for membership in <b>Mount Diablo Astronomical Society</b>. Already a member? Click <a href="club-apply.cfm?Club_ID=51&ApplicantType=Member">here</a> to register with the Night Sky Network.
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					<P><strong>We invite you to become a member of the Mount Diablo Astronomical Society and enjoy all the benefits of membership.</strong><br /><br />Initial dues for new members is $25. Membership dues include all members of your immediate family at the same address.<br /><br />Please complete this form and we will contact you with additional information.</P>
				

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						<LI><A HREF="http://www.mdas.net/mdas_store.html" TARGET="_blank">To pay initial dues of $25, please click here and choose 'New Member Registration'</A></LI>
						
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										<option value=''>(select state or territory)</option>
										
											<OPTION VALUE="AL">Alabama</OPTION>
										
											<OPTION VALUE="AK">Alaska</OPTION>
										
											<OPTION VALUE="AZ">Arizona</OPTION>
										
											<OPTION VALUE="AR">Arkansas</OPTION>
										
											<OPTION VALUE="CA">California</OPTION>
										
											<OPTION VALUE="CO">Colorado</OPTION>
										
											<OPTION VALUE="CT">Connecticut</OPTION>
										
											<OPTION VALUE="DE">Delaware</OPTION>
										
											<OPTION VALUE="FL">Florida</OPTION>
										
											<OPTION VALUE="GA">Georgia</OPTION>
										
											<OPTION VALUE="HI">Hawaii</OPTION>
										
											<OPTION VALUE="ID">Idaho</OPTION>
										
											<OPTION VALUE="IL">Illinois</OPTION>
										
											<OPTION VALUE="IN">Indiana</OPTION>
										
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											<OPTION VALUE="KS">Kansas</OPTION>
										
											<OPTION VALUE="KY">Kentucky</OPTION>
										
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											<OPTION VALUE="ME">Maine</OPTION>
										
											<OPTION VALUE="MD">Maryland</OPTION>
										
											<OPTION VALUE="MA">Massachusetts</OPTION>
										
											<OPTION VALUE="MI">Michigan</OPTION>
										
											<OPTION VALUE="MN">Minnesota</OPTION>
										
											<OPTION VALUE="MS">Mississippi</OPTION>
										
											<OPTION VALUE="MO">Missouri</OPTION>
										
											<OPTION VALUE="MT">Montana</OPTION>
										
											<OPTION VALUE="NE">Nebraska</OPTION>
										
											<OPTION VALUE="NV">Nevada</OPTION>
										
											<OPTION VALUE="NH">New Hampshire</OPTION>
										
											<OPTION VALUE="NJ">New Jersey</OPTION>
										
											<OPTION VALUE="NM">New Mexico</OPTION>
										
											<OPTION VALUE="NY">New York</OPTION>
										
											<OPTION VALUE="NC">North Carolina</OPTION>
										
											<OPTION VALUE="ND">North Dakota</OPTION>
										
											<OPTION VALUE="OH">Ohio</OPTION>
										
											<OPTION VALUE="OK">Oklahoma</OPTION>
										
											<OPTION VALUE="OR">Oregon</OPTION>
										
											<OPTION VALUE="PA">Pennsylvania</OPTION>
										
											<OPTION VALUE="RI">Rhode Island</OPTION>
										
											<OPTION VALUE="SC">South Carolina</OPTION>
										
											<OPTION VALUE="SD">South Dakota</OPTION>
										
											<OPTION VALUE="TN">Tennessee</OPTION>
										
											<OPTION VALUE="TX">Texas</OPTION>
										
											<OPTION VALUE="UT">Utah</OPTION>
										
											<OPTION VALUE="VT">Vermont</OPTION>
										
											<OPTION VALUE="VA">Virginia</OPTION>
										
											<OPTION VALUE="WA">Washington</OPTION>
										
											<OPTION VALUE="WV">West Virginia</OPTION>
										
											<OPTION VALUE="WI">Wisconsin</OPTION>
										
											<OPTION VALUE="WY">Wyoming</OPTION>
										
											<OPTION VALUE="DC">District of Columbia</OPTION>
										
											<OPTION VALUE="AS">American Samoa</OPTION>
										
											<OPTION VALUE="FM">Federated States of Micronesia</OPTION>
										
											<OPTION VALUE="GU">Guam</OPTION>
										
											<OPTION VALUE="MH">Marshall Islands</OPTION>
										
											<OPTION VALUE="MP">Northern Mariana Islands</OPTION>
										
											<OPTION VALUE="PW">Palau</OPTION>
										
											<OPTION VALUE="PR">Puerto Rico</OPTION>
										
											<OPTION VALUE="VI">Virgin Islands</OPTION>
										
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										<div class='zip_container'><label for='Zip_1'>Zip</label><input id='Zip_1' maxlength='10' name='Zip_1' size='5' type='number' value=''>
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						<li class='gradient_line'></li>
					
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							<fieldset class='address'>
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									<li>
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									</li>
								
								
									<li>
									<div class='state_container'>
										<label for='State_2'>State</label>
										<select id='State_2' name='State_2'>
										<option value=''>(select state or territory)</option>
										
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											<OPTION VALUE="AZ">Arizona</OPTION>
										
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											<OPTION VALUE="CA">California</OPTION>
										
											<OPTION VALUE="CO">Colorado</OPTION>
										
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											<OPTION VALUE="DE">Delaware</OPTION>
										
											<OPTION VALUE="FL">Florida</OPTION>
										
											<OPTION VALUE="GA">Georgia</OPTION>
										
											<OPTION VALUE="HI">Hawaii</OPTION>
										
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											<OPTION VALUE="IL">Illinois</OPTION>
										
											<OPTION VALUE="IN">Indiana</OPTION>
										
											<OPTION VALUE="IA">Iowa</OPTION>
										
											<OPTION VALUE="KS">Kansas</OPTION>
										
											<OPTION VALUE="KY">Kentucky</OPTION>
										
											<OPTION VALUE="LA">Louisiana</OPTION>
										
											<OPTION VALUE="ME">Maine</OPTION>
										
											<OPTION VALUE="MD">Maryland</OPTION>
										
											<OPTION VALUE="MA">Massachusetts</OPTION>
										
											<OPTION VALUE="MI">Michigan</OPTION>
										
											<OPTION VALUE="MN">Minnesota</OPTION>
										
											<OPTION VALUE="MS">Mississippi</OPTION>
										
											<OPTION VALUE="MO">Missouri</OPTION>
										
											<OPTION VALUE="MT">Montana</OPTION>
										
											<OPTION VALUE="NE">Nebraska</OPTION>
										
											<OPTION VALUE="NV">Nevada</OPTION>
										
											<OPTION VALUE="NH">New Hampshire</OPTION>
										
											<OPTION VALUE="NJ">New Jersey</OPTION>
										
											<OPTION VALUE="NM">New Mexico</OPTION>
										
											<OPTION VALUE="NY">New York</OPTION>
										
											<OPTION VALUE="NC">North Carolina</OPTION>
										
											<OPTION VALUE="ND">North Dakota</OPTION>
										
											<OPTION VALUE="OH">Ohio</OPTION>
										
											<OPTION VALUE="OK">Oklahoma</OPTION>
										
											<OPTION VALUE="OR">Oregon</OPTION>
										
											<OPTION VALUE="PA">Pennsylvania</OPTION>
										
											<OPTION VALUE="RI">Rhode Island</OPTION>
										
											<OPTION VALUE="SC">South Carolina</OPTION>
										
											<OPTION VALUE="SD">South Dakota</OPTION>
										
											<OPTION VALUE="TN">Tennessee</OPTION>
										
											<OPTION VALUE="TX">Texas</OPTION>
										
											<OPTION VALUE="UT">Utah</OPTION>
										
											<OPTION VALUE="VT">Vermont</OPTION>
										
											<OPTION VALUE="VA">Virginia</OPTION>
										
											<OPTION VALUE="WA">Washington</OPTION>
										
											<OPTION VALUE="WV">West Virginia</OPTION>
										
											<OPTION VALUE="WI">Wisconsin</OPTION>
										
											<OPTION VALUE="WY">Wyoming</OPTION>
										
											<OPTION VALUE="DC">District of Columbia</OPTION>
										
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											<OPTION VALUE="PR">Puerto Rico</OPTION>
										
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										</select>
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