WHOI Associates Enrollment Form

Woods Hole Oceanographic Institution Associates Program Membership Enrollment Form Please print out this form and return it via mail or fax. Thank you!

Yes, I (We) would like to support the Woods Hole Oceanographic Institution's mission at the level of:

	$100 - $499	Associate
	$500 - $999	ALVIN Associate
	$1,000 - $4,999	KNORR Associate
	$5,000 - $9,999	ATLANTIS Associate
	$10,000 - $24,999	OCEANUS Associate
	$25,000 or more	METEOR Associate

First Name: ______________________	Last Name: __________________________
Address: ______________________________________________________________
City: ____________________________	State: _____________ Zip Code: _________
Telephone: _______________________	E-mail: ______________________________

Payment Method:

Checkbox Check -- Please make check payable in U.S. dollars to: Woods Hole Oceanographic Institution.

VISA, MasterCard, or American Express

Credit Card Number: ________________________ Expiration Date : ______/______

Name of Cardholder: ___________________________________________________

Signature of Cardholder: _________________________________________________

Checkbox I would like my gift to be anonymous.

Please send me information about how to include the Woods Hole Oceanographic Institution in my estate plans.

The Woods Hole Oceanographic Institution is a 501 (C) (3) not-for-profit organization. Gifts to the Institution are tax deductible as allowed by law. Please mail your check with this form. You may fax this form if you are paying by credit card. Mail to: Associates Program Development Office, MS#40 Woods Hole Oceanographic Institution Woods Hole, MA 02543 (508) 289-4895 Fax to: (508) 457-2167

Return to the WHOI Associates Program page

	I would like my gift to be anonymous.
	Please send me information about how to include the Woods Hole Oceanographic Institution in my estate plans.