Name and Contact Information

• First Name*:
• Middle Name:
• Last Name*:
• Nickname:
• Primary Email*:
• Alternate Email:
• Primary Phone:
• Alternate Phone:
• SMS (Text) Address:
  (must be formatted as an Email address, e.g. 5555555555@verizon.net)
• Organization/Employer:

Your Location

• Street Address:
• City:
• State: (select one) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massacusetts 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 American Samoa District of Columbia Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands U.S. Virgin Islands
• Zip Code:

Member Preferences
• PERSONAL INFORMATION DISPLAY PREFERENCES ON CLUB ROSTER
  (Visible Only to Club Members)
• OK to display name?
  Yes

  No
• OK to display email address?
  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
• Receive Emailed Club Newsletter?
  Yes

  No
• Receive Emailed Night Sky Network Newsletters?
  Yes

  No
• Group Emails OK?

• Additional Comments: