NSS WikiNSS CHAPTER APPLICATION DATE ____________________ PROPOSED CHAPTER NAME ___________________________________________________ We, the Chapter Officers, have read the “Chapter Rules” and agree to abide by these rules and amendments duly passed on by the National Space Society Board of Directors. President(Print)__________________________ Sign)__________________________ Secretary __________________________ __________________________ Treasurer __________________________ __________________________ Please attach copies of your chapter bylaws and membership list, which must include addresses and phone numbers (in order to be eligible you must have at least three current NSS members).Send a copy to the Vice President for chapters by email to(Candace.Pankanin@nss.org with New Chapter in the subject line)or by US mail to Candace Pankanin, 300 Gorge Rd, #66, Cliffside Pk, NJ 07010 and and one(1)paper copy to: NSS Headquarters, Attn: Chapters. 1620 I (Eye) Street NW, Suite 615 Washington, DC 20006 NOTE: Upon approval of your chapter application, the following information will be published in the NSS Chapter list printed in Ad Astra, and will be posted in the Chapter List on the NSS web site. Please place a check mark next to the phone number you will be using. NAME OF CHAPTER CONTACT _________________________________________________ CONTACT’S ADDRESS _______________________________________________________ CITY _______________________________ STATE _______ZIPCODE__________ HOME PHONE ___________________________WORK PHONE_________________________ OPTIONAL ALTERNATE CHAPTER CONTACT to be listed on website: NAME______________________________________________________________________ email______________________________Phone Number___________________________ EMERGENCY CHAPTER CONTACT, Unlisted, different from Primary Contact above NAME______________________________________________________________________ email________________________________Phone Number_________________________