Secure Online S.C.I.E.N.C.E. Fund Donation Form

YES! I want to support Pacific Science Center!

Please fill out the following donation form, then click the Submit button. The form will be submitted on our secure server. If you have questions or would like more information, please email sciencefund@pacsci.org or call (206) 443-3642.

Hint: to avoid submitting an incomplete form, please use the tab key
or the mouse to move from field to field. Do not use the return or enter keys.

Donation

All fields required unless noted.

S.C.I.E.N.C.E Fund Levels:

Or Enter Another Donation Amount:

 $.00 U.S. Dollars
How would you like to be acknowledged: (If anonymous, please indicate.)

Contact Information

Name/Contact Person:

Title (if applicable):

Company (if applicable):

Pacific Science Center membership number (if applicable):

Street Address 1:

Street Address 2:

City:

State:

Zip/Postal Code:

Country:

Email address:

Phone:

Fax (optional):

Billing Information

Credit Card Type:

Credit Card Number:

Credit Card Expiration Date:

Name as it appears on the credit card:

If the billing name and address is the same as the contact name and address above, please choose "Yes." Otherwise, please enter the billing information below.

Is the billing address the same as above?

Name:

Company (if applicable):

Street Address 1:

Street Address 2:

City:

State:

Zip:

Country:

Additional Comments and Suggestions

Please enter any additional information you want to share here: