*Name: First,  Middle Initial,  Last   (and Certification Initials, if any) :
*Company Name or Institution :
*Your Street Address :
*Your City :
 State : *Zip Code : Nation :

*Area Code : *Telephone Number : Fax :

 
*Your Email Address :

Note: If you have an email address at YAHOO.COM, any email sent to you from ClearStar will most likely end up in your Yahoo Spam folder.
 

* How or from whom did you hear about ClearStar?

 

*Amount of Payment - Choose correct category below. All funds USD 
for Regular ClearStar Members
who are not members of ALOA, SAVTA, or ILA


1 Year is   $   75
2 Years is $ 145   $  5.00 savings
3 Years is $ 215   $ 10.00 savings
Life Membership is $ 395 includes Life Member Designation LCSM ----
                                            The pro-rated amount of your current
                                            membership will also be subtracted from this.


for ALOA or ILA Members ONLY :

1 Year is  $   60
2 Years... $ 115   $  5.00 savings
3 Years... $ 170   $ 10.00 savings
Life Membership is $ 385 includes Life Member Designation LCSM ----
                                            The pro-rated amount of your current
                                            membership will also be subtracted from this.

for SAVTA Members ONLY :

1 Year...   $   60
2 Years... $ 115   $  5.00 savings
3 Years... $ 170   $ 10.00 savings
Life Membership is  $ 370 includes Life Member Designation LCSM ----
                                            The pro-rated amount of your current
                                            membership will also be subtracted from this.

*I am paying my dues by - Select A Payment Method:
Credit Card now
Credit Card via Fax 1-866-850-9926 (toll free)
Check via Postal Mail


If paying by Credit Card now fill in the boxes below...

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Select One


*Card Number
*Expiration Date
4 digits only
2 for Month and
2 for Year

example: 1014


*Card ID Number (CVV2, CID)--------------->

3 digits on back of VISA and Mastercard

( 4 digits on front of American Express card)

examples: 678  or  1234



If you are a member of ALOA, SAVTA or ILA - Fill in the boxes below
 
I hereby swear that I am a current
paid-up member of
at least one of the following...
ALOA, SAVTA or ILA

Signature - Type in Name
For members of

ALOA, SAVTA or ILA

My Assoc. Membership Number is...



If you are paying by credit card click (only once) the Submit Payment button below...

                                          


If you are faxing or mailing your payment,
print this completed form and include it with your payment, and...




Fax Number: 1-866-850-9926 (toll free)

Mailing Address:

ClearStar Security Network
Internet Administration
4454 Lopez Ave
Port Townsend, WA 98368



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