Official MESAS MEMBERSHIP Form

Sponsored by S.C. Academy of Science

INSTRUCTIONS:

1. Print CLEARLY in the boxes below.  Have your parent or legal guardian fill in the parent's information (if your parent works, please ask them to give us a work number, if possible). Finally, ask your teacher/sponsor to fill in the school / teacher information.
2. Attach a check in the amount of $5.00 for each student. Checks should be made payable to  MESAS.
3. Mail to: Dr. Don M. Jordan, SCAS / USC College of Arts & Sciences / Room 323 Sumwalt / Columbia SC 29208.

 
  Student's Home Information Parent's Home Information
NAME    
ADDRESS   *
CITY / STATE / ZIP   *
AREA CODE / PHONE #   *
SCHOOL NAME   WK. PHONE #
GRADE IN SCHOOL   N/A

* FILL IN IF DIFFERENT FROM STUDENT'S ADDRESS / HOME PHONE

  Teacher's School or Adult Sponsor Information
NAME  
ADDRESS OF SCHOOL   
CITY / STATE / ZIP  
AREA CODE / PHONE #  
SCHOOL REGION  
PRINCIPAL'S NAME  

SEND TO:
Dr. Don Jordan
MESAS State Director and Founder
South Carolina Academy of Science
Room 323 Sumwalt / College of Arts & Sciences / Center for Sci Education / USC / Columbia SC 29208
Phone: (803) 777-7007
FAX: (803) 777-4396
E-Mail: jordan@gwm.sc.edu