Utah Membership Payment

ARCS® FOUNDATION, INC.
Advancing Science in America®
MEMBER CONTRIBUTION FORM 2019-2020
(Note: Membership and Fiscal Year begins on July 1st)

If you are using a credit card for payment consider adding an "Other Amount" to cover the 2.3% credit card processing fees. If you are paying just the $600 membership fee, the "Other Amount" would be $13.80. If you would like to donate an additional $200, enter $218.40 for the "Other Amount", for $400 enter $423, for $900 enter $934.50. This helps make sure all our contributions go directly to scholarships!

New Member Sign-up

Membership *

Active Member (Utah) - $ 600.00

Contribution Amount *

Additional Scholarship Amount - $ 200.00

Additional Scholarship amount - $ 400.00

Additional Scholarship amount - $ 900.00

No thank you

Other Amount

Other Amount $

Total Amount

Member Profile

(1) Please review your information and update as needed
(2) Scroll to the bottom and save your information.
(3) If your information does not save correctly, contact is.help@arcsfoundation.org.

Title/Prefix

First Name *

Nickname (if preferred)

Middle Name

Last Name *

Individual Suffix

Preferred Communication Method (Primary)

Email
Postal Mail
SMS (text)
Phone

Email (Primary) *

Email (Other)

Street Address (Primary)

Address Line 2 (Primary)

City (Primary)

State (Primary)

Zip Code (Primary)

Phone (Primary)

Phone (Mobile)

Phone (Work)

Phone (Other)

Fax

If you need to delete your Other address, please erase the fields Line Address 2 (Other), City (Other), State (Other) and Zip Code (Other) and enter a . in Street Address (Other)

Street Address (Other)

Address Line 2 (Other)

City (Other)

State (Other)

Zip Code (Other)

Website - Personal

Website - Work

Instagram

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Twitter Handle

Facebook

Please provide a headshot of yourself not to exceed 4 megabytes

Photo

Current Employer

Occupation or Profession

Organization(s) I am affiliated with

Employer Matching Funds

Yes No

Education

Person(s) who sponsored and/or introduced you to ARCS

Year Joined ARCS Foundation

Spouse / Significant Other Name

Spouse / Significant Other Occupation or Profession

Spouse/Significant Other Current/Past Employer

Spouse / Significant Other Education

ARCS Foundation--Utah Chapter
1338 S Foothill Dr #324, Salt Lake City, UT 84108

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