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SPACEWALK
APPLICATION |
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JOHN F.
KENNEDY SPACE
CENTER | |
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The NASA Alumni League
Florida Chapter The Astronauts Memorial Foundation |
YES! Please inscribe
the following name on a brick on SPACEWALK at the Kennedy Space
Center.
(Each inscription is limited to
12 characters
per line on two lines, including spaces and
punctuation.)
- INFORMATION ON THE PERSON
WHO'S NAME IS BEING INSCRIBED
|
| Name |
_____________________________________________________ |
| Street |
__________________ |
City |
___________________ |
State |
_________ |
Zip |
__________ |
| Phone |
(___)_____________Fax
(___)____________E-Mail_______________________ |
|
| Please enter the
following information on this person into the SpaceWalk database. I
have limited the description to 50 words or less. I understand that
the NASA Alumni League and The Astronauts Memorial Foundation
reserves the right to review and approve any information. |
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________ |
|
- INFORMATION ON PERSON PURCHASING THIS
INSCRIPTION
|
| Name |
_____________________________________________________ |
| Street |
_________________ |
City |
___________________ |
State |
_________ |
Zip |
__________ |
| Phone |
(___)_____________Fax
(___)_____________E-Mail_______________________ |
|
|
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| |
Check Payable to SpaceWalk in the
amount of $75.00 (U.S.) |
| |
Please charge
my MasterCard / VISA
the amount of $75.00 (U.S.) |
|
Account
Number_________________________ Expiration Date___________ |
Signature_______________________________ |
|
| COMPLETE
THIS FORM AND |
| FAX to
321-452-6244 |
| OR MAIL
TO: |
| SpaceWalk
of Honor |
| Mail Code
AMF |
| Kennedy Space Center, FL
32899 |
| You may also purchase an inscription by calling
1-800-792-3494 |
The Astronauts Memorial Foundation is a
private, not-for-profit 501 (c)(3) organization and your contribution is
deductible to the limits allowed by law. The Foundation estimates
that the total $75 cost of each inscription is tax deductible and
recommends that you direct any questions to your professional tax
adviser.
A copy of the official registration and
financial information of The Astronauts Memorial Foundation may be
obtained from the Division of Consumer Services, State of Florida, by
calling 1-800-435-7352 toll-free within the State . Registration
does not imply endorsement, approval or recommendation by the State of
Florida.
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