MEMBERSHIP FORM NAME: ADDRESS: CITY/STATE/ZIP: PHONE: FAX: CONTACT PERSON: E-MAIL: MEMBERSHIP LEVEL: Please Select One Individual Family Sustaining (Individual) Sustaining (Corporate) Corporate Friend Corporate Patron Corporate Champion
MEMBERSHIP FORM
NAME:
ADDRESS:
CITY/STATE/ZIP:
PHONE: FAX:
CONTACT PERSON:
E-MAIL:
MEMBERSHIP LEVEL: Please Select One Individual Family Sustaining (Individual) Sustaining (Corporate) Corporate Friend Corporate Patron Corporate Champion
Please make checks payable and mail with form to:
NEVADA TEST SITE HISTORICAL FOUNDATION 755 E. Flamingo Road Las Vegas , NV 89119 Or call: 702-895-0479