VAST Membership Form

Please register below to become a member of the Virginia Association of Science Teachers. Members get free admission to the Science Museum of Virginia and the Virginia Museum of Natural History, and regular issues of the VAST newsletter, "The Science Educator". (fields marked with * required).

*Member Status:	New Member Renewing Member
*First Name:
*Last Name:
*Home Phone:
*Email Address:
*Home Address:
*City:
*State:	*Zip:

*Dues:	One (1) year - $25.00 Three (3) years - $60.00 Life Membership - $200.00 FULL-TIME student - $10.00 Retired VAST member - $10.00 One year Corporate Membership - $150.00 One year Corporate Benefactor - $500.00

School District (city/county/private) or Company:
School Name:
Are you a Point-of-Contact (BaP) for your school?	Yes No
Level:
Specialty/Certification (select all applicable):	Biology/Life Science Chemistry Earth Science Elementary Envi. Science Physics/Physical Science Other

Corporate members and Benefactors receive a 20% discount on Advertising and Exhibitor Fees. Membership renewed in September or at the Annual Professional Development Institute will be extended a full year after the following January. Please note: although the application process is initiated on-line, payment must be received before process is complete. Please send check or money order to: VAST 134 Twin Lake Circle Newport News, VA 23608