Institutional Mercury Subscription Order/Renewal Form

Please fill out the form below and mail or fax to:

ASP
Attn: Membership
390 Ashton Avenue
San Franciso, CA 94112

Fax orders to: 415-337-5205

Subscription Type:  

Subscription rate is $72 per site.

___ New Order

___ Renewal

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).

 

 

 

 

 

 

 

 

 

 

 

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.



 

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