UACNJ Member Clubs Form - 2003

CLUB: ________________________________________________________________
Address: _______________________________________________________________
Town:__________________ State:_________________ Zip Code:__________________
Phone:(____)____-________ Fax:(____)____-________ Email:_____________________
CLUB President: _______________________________________________________
Address: _______________________________________________________________
Town:__________________ State:_________________ Zip Code:__________________
Phone:(____)____-________ Fax:(____)____-________ Email:_____________________
CLUB Newsletter Editor: _________________________________________________
Address: _______________________________________________________________
Town:__________________ State:_________________ Zip Code:__________________
Phone:(____)____-________ Fax:(____)____-________ Email:_____________________
CLUB UACNJ Representative: ___________________________________________
Address: _______________________________________________________________
Town:__________________ State:_________________ Zip Code:__________________
Phone:(____)____-________ Fax:(____)____-________ Email:_____________________
CLUB UACNJ Alternate: ________________________________________________
Address: _______________________________________________________________
Town:__________________ State:_________________ Zip Code:__________________
Phone:(____)____-________ Fax:(____)____-________ Email:_____________________
Information provided by ____________________________________ on ____________
Annual Club UACNJ Membership ($25.00/year)
ALL forms should be returned no later than Mar. 15th,2003 		$__________
Jenny Jump Supporting Club (Additional $1.00/member in club/year -
optional except to clubs with an observatory at Jenny Jump) 		$__________
Total: $__________
Return to: UACNJ Credentials Chairman - Ron Russo, 447 Hillside Avenue, Orange, NJ 07050
E-mail: roned@webexpert.net