OAS and OJAS Membership

Membership Application or Renewal

Last Name:
First Name:
 M.I.
School Affiliation (if any):
PHONE:
E MAIL ADDRESS:
PROFESSIONAL ADDRESS:
Department (Organization): 
Street or P.O. Box: 
City: 
 StateZip 
Telephone: 
E-Mail: 
MAILING ADDRESS (if different):
Street or P.O. Box: 
City: 
 StateZip

MEMBERSHIP RENEWAL orNEW MEMBER

SECTION AFFILIATIONS

STUDENT SECTIONS: (Collegiate = Y; High School, Junior High School, Middle School = Z)
Collegiate choose Y as 2 or 3. Junior choose Z as 2 or 3.
Primary Interest
Secondary Interest
Tertiary interest

PAYMENT SUMMARY

Membership Type 
General Endowment Contribution 
TOTAL ENCLOSED 

Make checks payable to the Oklahoma Academy of Science and send them, with this form, to:

Oklahoma Academy of Science
University of Central Oklahoma Campus Box 90
Edmond, OK 73034