Invitation for Membership

Please sign me up as a member of the Rockville Consortium for Science.

Name:____________________________________________________________

Address:__________________________________________________________

City:______________________________State:______Zip Code:_____________

Phone:_______________________(home)__________________________(work)

Internet E-mail:_____________________________________________________

Check your areas of interest:

[_]   I would like to help with Rockville Science Day.
[_]   I support the establishment of a science center in Rockville.
[_]   I want to participate in establishing the science center.

Send this form to:

Bob Ekman
524 Carr Ave.
Rockville, MD 20850

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Last Updated on April 9, 2006
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