Foresight Institute
Membership Application

PLEASE PRINT
and fax or mail this form to:
Foresight Institute, Box 61058
Palo Alto CA 94306 USA
Tel: 415-917-1122 Fax: 415-917-1123


Yes, I support the Foresight effort. Keep me informed about Foresight's work over the next year. My donation is enclosed, payable to the Foresight Institute. Foresight is a nonprofit foundation; donations are tax-deductible in the U.S. to the full extent permitted by law. Donations can be made by check from a U.S. bank, postal money order, VISA, or Mastercard. Credit card donations may be sent by fax.

Enclosed is my contribution to the Foresight Institute
for a new or continuing membership at the following level:
Basic$35 Other $________
Contributing$50 If you would like to donate
$250 or more per year,
please consider Foresight's
Senior Associate Program.
Supporting$100
A matching gift will be made by my company

Name: _______________________________________________

Address: ______________________________________________

City, State: ____________________________________________

Zip Code/Postal Code, Country: ___________________________

Optional Information:

Work Phone: __________________________ Home Phone: __________________________

Fax: __________________________Email: _________________________________

VISA or MasterCard Number:____________________________

Exp. Date:___________ Month/Year

Signature ________________________________

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