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Click Donate to ACSH to subscribe online, or alternatively complete, print and fax or mail this form to:

ACSH Membership
1995 Broadway - 2nd Floor
New York, NY 10023-5860

Fax: (212) 362-4919 | Phone: (212) 362-7044

Membership Application

A financial contribution to ACSH entitles you to receive all new ACSH publications as they are released, and a 25% discount on all additional ACSH publication purchases. All contributions are tax-deductible as permitted by law.

Ο Yes, I want to join ACSH. I wish to donate    $ _______________

Ο  Member $50
Ο  Associate $100
Ο  Nader-Buster $250
Ο  Partner-In-Science $500
Ο  President’s Club $1,000
Ο  Chairman’s Circle $5,000
Ο  Leadership Council $10,000

Ο  My employer’s Matching Gift Form is enclosed.

Method of Payment

Ο  Check   Ο  VISA   Ο  MasterCard 

Name (please print)	_________________________
Account number	_________________________
Expiration date	_________________________
Signature	_________________________

Mailing Information
Name (please print)	_________________________
Address1	_________________________
Address2	_________________________
City/State	_________________________
Zip	_________________________
E-mail (optional)	________________________