Science Center & Museum Membership Science Center Member Application

Title (e.g. Executive Director, President) _____________________

Name of Institution _______________________________

Address ________________________________________________________

City ______________________________ State _____ Zip __________

Country ___________________

Telephone _____________________________ Fax ______________________

E-mail address ___________________________________________________

Web site address _________________________________________________

How did you learn about ASTC?_______________________________________

_______________________________________________________________

_______________________________________________________________

GENERAL

Is your institution nonprofit? ____Yes ____No

If located in the US, what is your tax status code?_________________________

STAFF

Please complete the following questions with information
from the most recently completed fiscal year.

What is the total number of paid employees? _________________________

Full-Time? _______________

Part-Time? _______________

Total Full-Time Equivalent? ________________

ATTENDANCE

What was the total on-site attendance for the last fiscal year? _________________

What was the total off-site attendance for the last fiscal year? _________________

What was the total number of students served in school groups
for the last fiscal year?

On-site: _______________

Off-site: _______________

FACILITY

Number of buildings for public use _____

If your institution has more than one building, please report the
combined square footage for each question below.
Please provide the following numbers in square feet, or indicate
unit of measure used.

What is the total interior public square footage of the museum?_________________

What is the total interior exhibition square footage? ______ (temp) ______
(PE) ______

What is the total interior classroom square footage? _______

What is the total outdoor exhibit area/science park square footage? _______

Does the museum have the following?

Other______________________________

FINANCES

Please answer all of the following questions based on your institution's
most recently completed fiscal year. Please provide the ending month/year of the
most recently completed fiscal year: ______/______.

What were the total operating expenses for operations your last fiscal year?

_______________________________________

What was the total operating income your last fiscal year?__________________

What was the total amount of earned income in your last completed fiscal year?

_______________________________________
(Earned income includes revenues from admissions, education program fees,
ancillary services fees [parking lots, food service, museum stores, etc.], membership
sales.)

What was the total amount of public funds received in your last
completed fiscal year?

______________________________________
(Public funds include federal grants, state/provincial grants, local
[e.g., county or city] grants, and direct tax support.)

What was the total amount of private funds received in your last
completed fiscal year?

______________________________________
(Private funds include grants or gifts received from individuals, corporations,
or foundations).

Are there major capital expansions/improvements planned for the next
two years? _______

If yes, please describe briefly_______________________________

______________________________________________________

PROGRAMS

Does your institution have any of the following educational programs?
(Please check all that apply):

___ Camp-In Programs ___ Classes and Demonstrations ___ Curriculum materials ___ Field Trips ___ School Outreach ___ Science Camps ___ Science Kits

___ Teacher Education Workshops ___ Youth Employment Programs ___ Youth Enrichment Programs (clubs/classes) ___ After-School Programs ___ Travel Programs/Expeditions ___ Virtual Visits

Other (please Specify):__________________________________

Are there any plans to increase educational offerings?_______
If yes, please describe ___________________________________

__________________________________________________________

Are there any programs with schools for students and/or teachers?________
If yes, please describe_______________________________________

___________________________________________________________

How many households are members of your institution?_________________

Please indicate the total number of the following at the close of the
last fiscal year:

Family memberships ____________
Individual memberships ____________
Senior memberships ____________

COMMUNICATIONS

ASTC is committed to providing its members with time-sensitive and up-to-date
information on issues of importance to the science center field. So that your
organization may benefit from these services, we request permission to send
you and/or your staff timely print, faxed, or e-mail communications, such as
ASTC INFORMS, ASTC SCANS, annual conference announcements, and related
marketing opportunities. Please indicate your institution's acceptance by
checking the box below.

[ ] As a benefit of membership ____________________________________
[name of institution] consents to receive communications sent by, or on behalf
of, the Association of Science-Technology Centers.

GOALS OF ASTC

Does your organization agree with ASTC's Statement on Science (listed below)?
____Yes ____No

Science is a human endeavor that uses observations and experimentation to
develop explanations of the natural world. Scientific theories are grounded
in and compatible with evidence, internally consistent, and demonstrably effective
in explaining a wide variety of phenomena. Science is based on hundreds of years
of scientific observation and experimentation and many thousands of
peer-reviewed publications.

Does your organization agree with and demonstrate a strong interest in the
goals of ASTC (listed below)? ____Yes ____No

• To further public understanding of science
• To show the impact of science and technology on society and culture
• To encourage diversity and participation by all peoples in the scientific
  enterprise, especially women, minorities, and other groups
  underrepresented in scientific and technological careers
• To serve as a vehicle for cooperative projects of mutual interest to its
  membership
• To advance the role of science and technology centers in society
• To cooperate with other educational agencies and organizations to
  further common goals.

Please send as many of the following materials as you can provide
for the ASTC Membership Committee's Review:

___ Annual report

___ list of principal staff, indicating title and department

___ brief biographical sketch for up to three principal staff listed above

___ brochures and other descriptive materials on your institution's exhibits,
programs, and facilities

___ black and white photographs of institution's exterior, interior, and of major
exhibits

___ building map or floor plan

___ recent press clippings

Dues: ______________ USD

___Payment by check (Check must be drawn on US Bank)

Payment by Credit Card:
___American Express
___MasterCard
___Visa

Credit Card Number __________________________

Expiration Date:___________________

Print Name as it appears on card _____________________________

Signature of Card Holder ___________________________________

ASTC reserves the right, in its sole discretion, and for any lawful reason, to reject
any application for membership.

Please mail this application and your supporting materials to:

ASTC Membership
1025 Vermont Avenue NW
Suite 500
Washington, DC 20005-6310
U.S.A

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