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********************************************************* MEMBERSHIP APPLICATION FOR AMERICAN ATHEISTS, INC. ********************************************************* Last name: . . . . . . . . . . . . . . . . . .. . . . . . . First name: . . . . . . . . . . . . . . . . .. . . . . . . Companion's name (if family or couple membership): Last name: . . . . . . . . . . . . . . . . . . . . . . . . . First name: . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . City/State/Zip: . . . . . . . . . . . . . . . . . . . . . . . Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . This is to certify that I am/we are in agreement with the ``Aims and Purposes'' and the ``Definitions'' of American Atheists, Inc. I/we consider myself/ourselves to be Materialist or A-theist (i.e., Non-theist) and I/we have, therefore, a particular interest in the separation of state and church and American Atheists, Inc.'s efforts on behalf of that principle. I/we usually identify myself/ourselves for **public** purposes as (check one): __Atheist __Freethinker __Humanist __Rationalist __Objectivist __Ethical Culturalist __Unitarian __Secularist __Agnostic __Realist __I/we evade any reply to a query __Other: . . . . . . . . . . . I am/we are, however, an Atheist(s) and I/we hereby make application for membership in American Atheists, Inc., said membership being open *only* o Atheists. (Those not comfortable with the appellation ``Atheist'' may not be admitted to membership but are invited to subscribe to the _American Atheist Newsletter_. Both dues and contributions are to a tax-exempt organization and may be deducted on my/our income tax return(s) as subject to applicable laws. *(This application must be dated and signed by the applicant[s] to be accepted.)* Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . Membership in American Atheists, Inc. includes a subscription to the _American Atheist Newsletter_ and the _Members' Inside Report,_ as well as all the other rights and privileges of membership. Please indicate your choice of membership dues: __Life, $750 __Couple Life, $1000 __Sustaining, $150/year __Couple/Family, $75/year (Please give all names above.) __Individual, $50/year __Age 65 or over, $25/year (Photocopy of ID required.) __Student, $20/year (Photocopy of ID required.) __I am/we are enclosing a check or money order for $.... payable to American Atheists, Inc. __ Please charge my __VISA or __MasterCard for $..... Name on card: . . . . . . . . . . . . Credit card number: . . . . . . . . . Expiration date: . . . . . . Signature: . . . . .. . . . . . . . . . . . . . . . . . . . . . Return form to: American Atheists, Inc., P.O. Box 140195, Austin, TX 78714-0195. Telephone: (512) 458-1244. FAX: (512) 467-9525. *********************************************************************** * * * American Atheists website: http://www.atheists.org * * PO Box 140195 FTP: ftp://ftp.atheists.org * * Austin, TX 78714-0195 * * Voice: (512) 458-1244 Dial-THE-ATHEIST: * * FAX: (512) 467-9525 (512) 458-5731 * * * * Atheist Viewpoint TV: avtv@atheists.org * * Info on American Atheists: info@atheists.org, * * & American Atheist Press include your name and mailing address * * AANEWS -Free subscription: aanews-request@listserv.atheists.org * * and put "info aanews" in message body * * * * This text may be freely downloaded, reprinted, and/other * * otherwise redistributed, provided appropriate point of * * origin credit is given to American Atheists. * * * ***********************************************************************

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