NANPA Membership Application

NANPA Membership Application (July 1 - June 30)

For your practical use of this form, it contains no graphics or background colors. Just print it out or cut-and-paste it into email and send it via email, fax or mail to the NANPA office listed below. For more information on membership fees and benefits, check out the member information page. Thank you for joining NANPA!

Member Number (if known, for renewals): _______________

How did you hear about NANPA?

____________________________________________________________________________________

Please specify the address you wish your membership to be listed under.
Is this home______ business______ or both_____?

First name: ________________________________________

Middle initial: _________

Last name: ________________________________________

Suffix (e.g., M.D., D.D.S., Ph.D., etc.): _______

Company:____________________________________________________________________

Title: _________________________

Address:____________________________________________________________________

City: _______________________ State: ________ Zip:__________ Country: ___________

Business phone: _________________________ Home phone: _________________________ Fax:________________________

Email:______________________________________________

Web site:___________________________________________

Membership Fees:
General Member Dues $90 Joint Member Dues $120 (supply two names) Student Member Dues $25
Corporate/Institutional Member Dues:

Friends of NANPA $250-999 (Is this a Corporate Membership? _____ )
Bronze $1,000-2,499
Silver $2,500-4,999
Gold $5,000 and up

I am also donating additional amounts to the NANPA Foundation as follows:
General Contribution: $_______
Wildlife Refuge Blins Project: $_______
High School Scholarship Fund: $_______
College Scholarship Fund: $_______

TOTAL AMOUNT ENCLOSED $_______

PAYMENT TYPE: Check/Money Order (U.S. currency) Visa MasterCard

Card #: ___________________________________________________________________

Exp Date: ___________________

Name on Card: ____________________________________________________

Signature: _________________________________________________

Return form with your payment. Please make check or money order (in U.S. currency) payable to

NANPA
10200 W. 44th Avenue, Suite 304
Wheat Ridge, CO 80033

Membership includes subscription to NANPA newsletter, discounts for NANPA events, membership directory, and other benefits.

Demographics:
Please provide the following information so that we can serve you better. Thank you.

1. How would you describe your interest in Nature Photography? (check one)
_____ Full Time Professional Photographer _____ Part Time Professional Photographer
_____ Intermediate/Advanced Photographer _____ Amateur/Novice Photographer
_____ Educator _____ Photo Agent _____ Photo Editor/Publisher
_____ Other: ________________________________________________

2. What kind of Nature and Environmental Photography do you do? (check all that apply)
_____ Wildlife _____ Plant Life _____ Landscape _____ Underwater
_____ Close-up _____ Recreational/Adventure
_____ Positive Environmental (cleanups, new technology, planting, etc.)
_____ Negative Environmental (pollution, toxic wastes, garbage, etc.)
_____ Other:

3. Students only (check current status)
_____ Grade, Middle, or High School, Grade ______
_____ College, Year ________ _____ Graduate School
_____ Photography or Technical School

_____ Please withhold my name from third-party mailing lists.

_____ Please do not publish my information in the NANPA membership directory or website.

Parent's Signature (if applicant under 18) _______________________________

Send application to:

North American Nature Photography Association
10200 West 44th Avenue, Suite 304
Wheat Ridge, Colorado 80033-2840, USA
Phone: 303-422-8527, Fax: 303-422-8894
Email: info@nanpa.org