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Sigma Xi Membership FY2013 Reactivation Form

Thank you for choosing to reactivate your Sigma Xi membership!

This reactivation form is for Fiscal Year 2013 (July 1, 2012-June 30, 2013).

Any individual who has been inducted into Sigma Xi, may reactivate their lapsed membership at any time using the reactivation form below. By paying dues, you will receive American Scientist digitally and will have access to many other membership benefits.

Complete this online form or print the form and mail it to the address below. You may also call the administrative offices at 800-243-6534 or 919-549-4691 and provide this information over the phone.

IMPORTANT: When your original membership records are located, we will process your payment. If we cannot locate your records, we will contact you for additional information to assist in our search. Once the renewal is successfully processed, you will begin receiving mailings from Sigma Xi. Initial mailing will include a membership kit containing your membership identification card and member benefits. Please allow up to 6 weeks for delivery of your first mailing from Sigma Xi.

Do you know your Sigma Xi member ID number?     Yes No

Sigma Xi Member ID Number:

Last Name:

Please note: If last name different at time of election, please provide here:


All active (dues-paid) members will receive a digital version of American Scientist as a membership benefit. To ensure delivery of your digital issues, please verify your email address.

E-mail: * Required to receive your American Scientist digital issue

Please update your Member Profile with your current contact information, chapter affiliation and other information.

First Name:

Middle Name:

Prefix:     Suffix:

Elected By (which chapter):

Year Elected: (approximate, if unknown)

Current Mailing Address:

Address Line 1:

Address Line 2:

Address Line 3:

City:

State/Province:          Zip/Postal Code:

Country:

Home Telephone:

Business Telephone:

Fax:

Chapter Affiliation:

What is your work environment?

What is your field of work or study?

Primary Field:
Secondary Field:

Membership Types
Member   (US$90.00)
Member   (Pre-pay 2 years: US$180.00)
Member   (Pre-pay 3 years: US$270.00)
Emeritus (US$63.00 - Previous Emeritus status required)
Emeritus (Pre-pay 2 years: US$126.00 - Previous Emeritus status required)
Emeritus (Pre-pay 3 years: US$189.00 - Previous Emeritus status required)
Transitional (US$63.00)

To qualify for transitional dues please provide the following information (this must be recertified every year).

Institution from which you graduated:
Date of graduation:
Degree obtained:

 

Student (US$25.00)

To qualify for student dues please provide the following information (this must be recertified every year)

Current institution:
Expected date of graduation:
Expected degree:

 

Total Dues (7/1/12-6/30/13): US$
 
Local Chapter Dues (optional)
Click here to find your chapter local dues amount and enter it here.
US$
American Scientist Print Edition
To ensure delivery of your magazine issues, please verify your mailing address and other contact information online.
US$

US$

Payment Information

By filling out the following information, you are authorizing Sigma Xi to charge your credit card with the amount specified above.
Please note that this form is on a secure server. Any information you provide will be kept ONLY in a secured location and is encrypted upon submission.

Credit Card Type:  American Express Discover MasterCard Visa
Credit Card Number (do not enter spaces or dashes):
Expiration Date: Month    Year:
3 or 4 Digit Credit Card Security Code: Locate your security code
Name on Credit Card:
Credit Card Billing Address:
Credit Card Billing Zip Code:

Automatic Payment Options:

Select the categories you authorize Sigma Xi to charge your credit card in May of each year:

    Annual membership dues Yes No

    Local chapter dues (if any) Yes No

    American Scientist print version Yes No

Once you have completed the above information, please review it carefully before clicking the "Submit" button below. We encourage you to print the confirmation screen for your records.

 

 
Finance Department
Sigma Xi, The Scientific Research Society
3106 East NC Highway 54
P.O. Box 13982
Research Triangle Park, NC 27709
Telephone: 800-243-6534 or 919-549-4691
Fax: 919-595-8114
E-mail: finance@sigmaxi.org

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