Name of ANPR member we may thank for encouraging you to join/rejoin/renew (if applicable): ______________________

If new, how did you hear about ANPR? ________________________________________

Date__________

(If this is a gift membership, please include as much information below as possible. ANPR will need the rest of the information at a later date to complete the membership.)

Name(s) ________________________________________________

Address ________________________________________________

City ______________________ State _______ Zip+4 ____________

4-letter code of park/office where you work__________

(If an NPS code doesn't apply, use these: Retired = RETI, Former NPS Employee = XNPS, Student/Educator = EDUC, Park Supporter = PART)

Member's home phone __________________

Personal e-mail address _______________________________________

ANPR will use e-mail as an occasional - but critical - communication tool. We will not share your information with any other organization. It is our policy not to conduct ANPR business via NPS e-mail or phone.

Please select your job discipline:
___ Protection
___ Interpretation
___ Administration
___ Resources
___ Maintenance
___ Concessions
___ Park Partner
___ Other __________________________________________

NOTE: An annual membership runs from Jan. 1 to Dec. 31. First-time members who sign up after Sept. 30, 2010, won't be billed again until the following year's renewal period (you receive the rest of 2010 and all of 2011 for the annual fee).

Type of Membership (circle one)

Active (current and former NPS employees or volunteers)
-- Seasonal / Intern / Volunteer
Individual: $45
Joint: $85

-- Permanent NPS Employee or Retiree
Individual: $75
Joint: $145

Associate (not NPS employees)
-- Sustaining: $70
-- Full-time Student: $45

Library / Associate Organization Membership *
(two copies of each issue of Ranger sent quarterly)
$100
* Corporate donors and other special supporters, please check here

Life — beginning Jan. 1, 2008 (lump sum payment)
Active (all NPS employees/retirees)
Individual: $2,500
Joint: $3,000

Associate (other than NPS employees)
Individual: $2,500
Joint: $3,000

___ Yes, I authorize the entire life membership amount in one lump payment.

OR

___ Please bill me in three payments over three years. I understand that annual installments are $850 for individuals, $1,025 for joint membership. If full payment is not received by the third installment due date, the amount paid shall be applied at the current annual membership rate until exhausted. At that point the membership will be lapsed.