SCIzzL Individual Membership

Individuals may support SCIzzL activities by joining, for a suggested annual fee of $59.

Name:
Company:
Street:
More street:
City:
State:
ZIP:
Country:
Email:
Telephone:
Fax:
Amount you are paying:

Method of Payment: Check (Payable to SCIzzL, drawn on a US bank) Visa MasterCard
You can pay by credit card by filling out the following form. It is not secure (the same security level as email, approximately the same as using your card in a restaurant).

Exact cardholder name:
Card Number (1234-5678-1234-5678):
Expires (mm/yy):

Billing address for Card: (Required, unless same as above.)

Street:
More street:
City:
State:
ZIP:
Country:

SCIzzL is part of Santa Clara University, a nonprofit organization, Federal Tax ID: 94-1156617.