YES!  I would like to stash my cash with the NSS!

Please fold the completed form in half and secure with tape to mail.  Or fax to 256.851.9241.  You can download a printable Word document, or an RTF document.

Name: ___________________________________ (please print)

NSS Number:  _______________

Tel: _______________________   e-mail: _____________________________________

I would like to donate to the National Speleological Society:

____ $10  ____ $15  ____  $20  ____ $25  ____  Other

Frequency:

        ____ Just this once  ____ Once a month  ____ Quarterly  ____ Once every six months

Donations to begin in:  __________ (month)  __________ (year)

I would like my donation to be earmarked for the following restricted fund or for unrestricted use in the general operating fund:  (Mark one below)

       _____ Unrestricted

       _____ Endowment Fund

       _____ Save the Caves Fund

       _____ (Cave) Educational Grants

       _____ NSS Repair Funds

       _____ Ralph W. Stone Fund (Research Grants)

       _____ NSS Cave Preserve Fund

       _____ Other _________________________________________

For a complete list of NSS Funds, go to http://www.caves.org/nss-business/bog/sec-18.html and to http://www.caves.org/nss-business/bog/app-c.html for NSS funds held by the NSF.

Please charge the donation to my credit card:

          _____  VISA       _____  MasterCard

Credit Card Number:  ___ ___ ___ ___    ___ ___ ___ ___    ___ ___ ___ ___    ___ ___ ___ ___

     Expiration Date:    ____/____/____

Name as it appears on the credit card:  _____________________________________________

I authorize the NSS to charge my account the amount I have specified above at the interval indicated.  I understand that I may change the amount of my contribution or cancel this agreement by sending (e-mail, fax, snail-mail) written instructions to the NSS Office.

Your signature: _________________________________  Date ___/___/___

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