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Fields marked with a red asterisk * are required.  Enter "n/a" for fields that do not apply.
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Section I – Donor Information

*First Name(s):     *Last Name:  
Please provide an email address to receive confirmation of this transaction.
*E-Mail Address:
Please select your Country first.   If not found, select your Continent to bring up list.
*Street Address:
*State/Province:     Other:  
*Phone Number:      
*Current NSS Member?      Membership # (if known):  
Note:  Donations of $20 or more from non-members will automatically include first year membership in the National Space Society (unless the opt-out is taken below).

Section II – Contribution Information

*Contribution Amount:                
  ($5 minimum)            
Other information or questions:

(To pay by check or to provide credit card information by mail or fax, use the paper version of this form.)
*Credit Card Type:     Select VISA Select MasterCard Select American Express Select Discover/NOVUS
*Credit Card Number:
*Expiration Date: Month:       Year:  
*Cardholder's Name:

NSS is a non-profit 501(c)(3) organization.
Your contribution is tax-deductible to the extent permitted by law.


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Updated Tuesday, 21-Jun-2016 13:33:07 EDT
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