NCGR Membership Application						New Membership			Renewal
Contact Information
Name				Company
Mailing Address
City		State			Zip			Country
Phone	Mobile						Fax
Email			Website
NCGR Directory Listing: Please include my name address phone cell fax email website

Demographic Information
Occupation		Astrological Education? Type:
Birthdate (mm/dd/year)			Birth Time (am/pm)					Time Zone
Place of Birth					Lat.				Long.
May NCGR use this information for astrology research purposes? Yes No
Areas of Interest
Please send information on:	Education			Research		Chapters	Special Interest Groups

Chapter Affiliation

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I wish be listed as a Member-at-Large.

(You may select a chapter at any time by notifying NCGR.)

NCGR Statement of Purpose
According to NCGR’s Articles of Incorporation, the purpose of the organization is to support: · The active integration of astrology with other fields of scientific knowledge, and astrologers with other professionals · The promotion of astrology as a science, especially in respect to the fostering of research and the publication research results · The improvement of standards of astrological practitioners, in collaboration with other interested organizations · The sponsorship of courses and/or seminars in order to achieve any or all of the above goals I herewith apply for membership in the National Council for Geocosmic Research. I agree to abide by the purposes of the organization and with its bylaws and ethics code.
Signature:	Date:

Payment Information

Membership Type		1 Year	3 Year	Lifetime	*Couples receive one set of publications and two votes. Attach second sheet for additional member. Residents of other countries who are members of the: Ÿ Astrological Association of Great Britain Ÿ Astrological Lodge of London Ÿ Federation of Australian Astrologers may join NCGR at the U.S. membership rate.
Individual	United States	$55	$150	$900
	Canada/Mexico	$60	$165	$1000
	International	$65	$180	$1100
Couples	United States	$75	$210	$1300
	Canada/Mexico	$80	$225	$1400
	International	$85	$240	$1500

Enclosed is a check or money order (U.S. funds only), payable to NCGR.

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Exp. Date:

I need a membership card: Yes No

Send completed application to:

L.T. Wade, Exec. Sec., NCGR, 531 Main St #1612, NY, NY 10044-0114

execsec@geocosmic.org or (212) 838-NCGR (6247)