MEMBERSHIP APPLICATION http://www.sfi .org/ THE INTERNATIONAL STAR TREK FAN ASSOCIATION, INC. STARFLEET is the fan organization with something for everyone. Members the world over are united in appreciation of the human adventure that is Star Trek. Hundreds of chapters throughout the world link members to local fandom activities, as well as the central organization. Annual membership begins with a membership package containing membership card(s), certifi cate(s), a handbook, and a listing of chapters. In addition, yourwill recieve six issues of the Communiqué, our bi-monthly publication, which contains news and information on STARFLEET operations and chapter activities, convention information, and much more. Please allow 6-8 weeks for your membership packet to arrive. If you provide an e-mail address or self-addressed stamped postcard, you will be notifi ed as soon as your membership is processed. Contact CompOpsHELP@sfi .org or below P.O. Box if you haven’t heard anything after 8 weeks. We can only process memberships for one-year terms – please do not send funds for multiple-year renewals. To join STARFLEET, complete this form and mail with payment (US Funds payable to STARFLEET) or credit card information to: STARFLEET MEMBERSHIP PROCESSING • P. O. BOX 460 • GAITHERSBURG, MD 20884-0460 MEMBERSHIP RATES MEMBER INFORMATION MEMBERSHIP CIRCLE WHERE APPROPRIATE CLASSES USA CAN/MEX OTHER NAME: INDIVIDUAL $15 $16 $20 MAILING ADDRESS: DATE OF BIRTH: FAMILY OF 2 $22 $23 $27 CITY: STATE/PROVINCE: POSTAL CODE: FAMILY OF 3 $25 $26 $30 COUNTRY: TELEPHONE: FAMILY OF 4 $28 $29 $33 EMAIL: FAMILY OF 5 $31 $32 $36 CHAPTER AFFILIATION: RANK: FAMILY OF 6 $34 $35 $39 PAYMENT INFORMATION PERSONAL CHECK/MONEY ORDER NEW MEMBERSHIP CREDIT CARD MEMBERSHIP RENEWAL VISA/MASTERCARD CARD NUMBER EXPIRATION DATE SCC: DISCOVER CONTACT INFO HAS CHANGED Please Note: List all participating family member names in the section below. List SCC DATE AUTHORIZED SIGNATURE numbers only if renewing memberships FAMILY MEMBERSHIP MEMBER INFORMATION Please list additional family members here. Please print. FOR OFFICE USE FAMILY MEMBER NAME SCC NUMBERSRANK (IF APPLICABLE) DATE OF BIRTH CHAPTER ONLY 02 03 04 05 06 Family memberships are limited to six family members, and include one copy of each Communiqué issue per family membership. STARFLEET SCHOLARSHIP DONATION (OPTIONAL) STARFLEET, The International Star Trek Fan Association, in cooperation with Star Trek personalities, supports educational efforts with contributions made by our members. If you would like to support this effort, please make a donation (minimum $1 per box checked) to one (or more) of the following scholarship funds. Please note: Donations are not required, and must be included with your membership fees. Additional information on specifi c programs available upon request. Scholarship donations are not currently tax-deductible. LeVAR BURTON PATRICK STEWART MARINA SIRTIS ARMIN SHIMMERMAN Total Scholarship Donations Enclosed: $ JAMES DOOHAN DeFOREST KELLEY GEORGE TAKEI GENE RODDENBERRY FOR OFFICE USE ONLY LAW & ORDER SPACE EXPLORERS INTERNET ACCESS You can join STARFLEET International via the Internet by fi lling out the online Membership Form at: http://www.sfi .org/compops/database/join.asp 10 Sept. 2001 – Check http://www.sfi .org/ for updated form..