Please print off and return this form with your check payment to Delaware Teachers of Science to:
                                         Kathy Melvin
                                         526 Kates Way
                                         Smyrna, DE 19977

Circle one:     1 year $10.00      2 years $16.00      3 years $24.00      Life $100.00

Name______________________________   Home Phone_________________
E-mail address_______________________   Work Phone_________________
Home Address: Street or Box No._____________________________________
                            City or Town________________   State____   Zip___________
School Name_________________________   District____________________
School Address__________________________________________________
                           __________________________________________________
Level:  Elementary___          Middle/Jr. High___          Senior High___
            College___                Administration___           Other__________________
Major Subject Interest______________________________________________
New Membership: ___         Renewal___          New Address?: Yes___  or  No___