INA Membership Form

1. Please provide the following contact and shipping information:

2. Dr.

   Mr.

   Mrs.

   Ms.

   Mr. & Mrs.

   Miss

   Name
   Street address
   Address (cont.)
   City
   State/Province
   Zip/Postal code
   Country
   Work Phone
   Home Phone
   FAX
   E-mail

3. Please indicate your desired giving level and membership status:

   	Diver $40			Curator $1000
   	Seafarer $75			Excavator $2500
   	Surveyor $150			Navigator $5,000
   	Restorer $500			Student / Retiree $25 (Student must provide Student I.D.)

   Institutional $100 (Libraries, museums, etc.)

4. I/we would like to be a part of INA with a membership gift of $
5. I would like to pledge $ to be paid monthly quarterly.
   
6. (Optional) This is an Honorary Memorial gift for:
   
7. I have provided for INA in my will.

   I would like more information about providing for INA in my will.

   I would like information about how to make a gift to INA that increases my income and makes possible a current tax deduction.

8. (Optional) Please Notify:

                                 Address:

    9. I found out about INA from: 

If this form will not email, please print it out and mail it to the address below.  Thank you!