Chiefland Astronomy Village
Membership Application
Fill in the blanks, print and snail-mail to the address below.
Member Name:
Address:
City
State
Zip
Home Phone:
Work Phone:
eMail:
How long have you been an astronomer? Beginner Intermediate Advanced Expert Telescope/Type? Profession? How did you learn about us?
Initial membership application is $35. Renewals received before January 31st are $20. On February 1st Renewals revert to $35
Starting with 2006 CAV Memberships there will be CAV pins available.
If you want a free pin please include an extra $1.00 for shipping envelope. Please indicate on this Membership form you want a pin and included the additional $1.00
Please mail your check to: Jeannie Clark
5450 NW 52 Ct.
Chiefland, FL 32626
(Make Check Payable to Jeannie Clark)
Total Enclosed
No Membership confirmation will be sent, your cancelled check is your receipt.
Feel free to contact the following property owner for more information: