Institutional Mercury Subscription Order/Renewal Form
Please fill out the form below and mail to:
ASP
Attn: Membership
390 Ashton Avenue
San Franciso, CA 94112
| Subscription Type: | |
| Subscription
rate is $48 per site.
___ New Order ___ Renewal ___ New Order for 2009 and 2010 subscriptions, total of $96 Reminder: ASP Membership benefits are not included with the new Institutional Mercury Subscriptions. If you wish to receive these benefits, you must join the ASP as an Individual or Technical Member. More information on membership. E-mail address
for notification of electronic Mercury posting:_________________________________________ |
|
IP Addresses Enter your IP address(es) or range below for the subscribed site (campus or department). |
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|
| Institution Information | |
| ASP
Account Number |
_____________________________________________________
|
| Institution
Name |
_____________________________________________________
|
| Institution
Mailing Address |
_____________________________________________________
|
| Address
2 |
_____________________________________________________
|
| City |
_____________________________________________________
|
State |
________
|
| Zip |
_____________________________________________________
|
| Country |
_____________________________________________________
|
| Contact Information | |
| Contact
First Name |
_____________________________________________________
|
| Contact
Last Name |
_____________________________________________________
|
| Business
Phone |
_____________________________________________________
|
| E-mail |
_____________________________________________________ |
| Billing Information - Please select one method of payment | |
| Purchase
Order # or Reference # |
_____________________________________________________ |
| Payment
by check |
Please make checks payable to ASP. |
| Credit
Card Type |
___ Visa ___ MasterCard ___ Discover |
| Credit
Card Number |
_____________________________________________________ |
| Expiration
Date (MM/YY) |
_____________________________________________________ |
| Help us get to know you | |
| How
would you categorize your Institution? |
___ University
Library ___ Public Library ___ Observatory/Planetarium ___ Museum ___ Other ___________________________________________________ |
| ___ Occasionally, we exchange our membership list with organizations whose products or services we believe may be of interest to our members. If you prefer that we do not share your name, please check this box. | |