Shark Research Institute Membership Application

Please print and complete this application and mail with your payment to the address at the bottom of the form.

Name: ___________________________________________________________

Address: _________________________________________________________

         ____________________________________________________________

Daytime Phone: ____________________ Evening Phone: __________________

FAX: ____________________         Email: ______________________________

Affiliation(s): _______________________________________________________

Areas of special expertise: ___________________________________________

Areas of special interest: ____________________________________________

Please check the membership status you desire:
_____ Individual Membership ($35.00 annually)
_____ Family Membership ($50.00 annually)
_____ Club Membership ($100.00 annually)
_____ Patron ($250.00 annually)
_____ Corporate Sponsor ($2,500.00 annually)

Payment method: _____ Check	_____ Money Order	  ____Check to auto-renew your membership annually
Credit Card (MasterCard or Visa only):

Card #: __________________________________________________________

Exp. Date: ____________	Signature: __________________________________

Please send this completed application to:

               Shark Research Institute
               P.O. Box 40
               Princeton, NJ 08540

     Phone: (609) 921-3522    Fax: (609) 921-1505

The Shark Research Institute is a non-profit tax-exempt organization
         dedicated to the study and conservation of sharks.