COMPLIMENTARY CITIZENS FOR NUCLEAR TECHNOLOGY AWARENESS 2012 INDIVIDUAL MEMBERSHIP DUES

1. COMPLIMENTARY CITIZENS FOR NUCLEAR TECHNOLOGY AWARENESS 2012 INDIVIDUAL MEMBERSHIP DUES Your Help Makes the Difference!CNTA is where it is today and where it will be tomorrow because of your donation! You’re an important part of our team that gives us the opportunity to increase public knowledge of all things nuclear and gives our mission of providing factual, objective information on nuclear subjects a strong voice. We do this to improve public knowledge on the real benefits and comparative opportunities of nuclear activities, including nuclear production of electricity, nuclear medicine, food irradiation, national security, nuclear waste management and protecting our environment! Please consider joining at the Benefactor Level. It is the best value!. Membership Levels Name:_________________________________________ Employer:______________________________________ Home Address:_________________________________ _______________________________________________ _______________________________________________ Phone:_________________________________________ Email(s):_______________________________________ _______________________________________________ (We communicate by email, so your correct email is important! Don’t forget to include us if you change your email address during the year) Would you like to be included in our 2012 Membership Directory? ____Yes ____No ____Benefactor Level $125 Best Value! Members receive one ticket with reserved seating and one private reception ticket for the annual Edward Teller Lecture/Banquet, reserved seating at Up & Atom Breakfasts, quarterly newsletters, and notices of other events throughout the year. Free ‘guest ticket’ to bring a non-member guest to breakfast. ____Patron Level $70 Members receive reserved seating for the annual Edward Teller Lecture/Banquet, quarterly newsletters, and notices of other events throughout the year. Free ‘guest ticket’ to bring a non-member guest to breakfast. COMPLIMENTARY _______Sustaining Level $35 Members receive quarterly newsletters, and notices of other events throughout the year. ____Student Level $15 Members receive quarterly newsletters, and notices of other events throughout the year. You must be enrolled as a college or high school student . MAKE YOUR CHECK PAYABLE TO CNTA. PLEASE INCLUDE THIS COMPLETED FORM, WITH YOUR CHECK, SO WE CAN UPDATE OUR RECORDS. MAIL TO: 1204 WHISKEY RD, STE B, AIKEN, SC 29803 WE ARE A NON-PROFIT 501 (C ) 3 CLASSIFICATION TAX I.D. #57-0953103 (your contribution is tax deductible) CALL OR EMAIL IF YOU HAVE ANY QUESTIONS: 803-649-3456 OR CNTA@BELLSOUTH.NET Check the box if you would like to volunteer on a committee or at one of our events (we can always use more help!) _______Yes, I would like to help Committee____ Event ____ (Check one or both) Internal Use OnlyDate received: ___________ Check/Cash:_____________ Date Entered:_____________ Email Entered: ______________ Member card mailed:_______________ Comment:____________________________________________________________________________