NEW YORK BIOLOGY TEACHERS ASSOCIATION
MEMBERSHIP FORM

Affiliated with the National Association of Biology Teachers.
Member Association of the Science Council of New York City.

In order to promote scientific literacy, NYBTA is making a one year subscription to Discover Magazine available for $12.00 
to NYBTA members.
(Members with existing subscriptions can have their subscriptions extended for one year at this price.)
One year subscriptions to Discover Magazine can be obtained for non-members @ $15.00.

Please Print Clearly
New Member __
Renewal __

Last Name ________________________ First Name _________________________

Your Address ________________________________________________________

City ________________________ State _________ Zip Code _________________

Home Phone _______________________________

Email Address ______________________________


School or Affiliation ____________________________________________________

Affiliation Address _____________________________________________________

City ________________________ State _________ Zip Code _________________

Affiliation Phone ____________________________

Send Mail to ___home ___ or affiliation

Fees:
$20.00 membership in United States
$40.00 international membership (Discover Magazine is NOT available to addresses outside of the U.S.)

Enclosed:
NYBTA Membership $20.00
NYBTA Membership AND Discover Magazine $32.00
Discover Magazine Only $15.00

Send check or money order payable to NYBTA to:
NYBTA / Membership
P.O. Box 360192
Brooklyn, NY 11236-0192

Membership through 12/31/2006