MEMBERSHIP
APPLICATION FORM
Application Date ________________
Membership Levels
 Basic Membership
BASIC MEMBERSHIP — $79
“Circle of Discovery” Memberships:
• Unlimited admission for up to 4 named individuals
• Discounts on camps
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 The Einstein
 The Newton
 The Galileo
 The Copernicus
CIRCLE OF DISCOVERY
“Circle of Discovery” Memberships Benefits include:
• FREE unlimited admission year-round to the Science &
Discovery Center of Northwest Florida
• FREE or discounted general admission into nearly 300
science centers and museums through the Association of
Science and Technology Centers (ASTC) Reciprocal
“Passport” Program
• 10% Discount in the Science & Discovery Store
• Discount and priority registration on camps
• Discount on Birthday Parties
• Invitations to “Circle of Discovery” Member events
Plus, the additional benefits listed below:
The Einstein — $125
Circle of Discovery Membership Benefits above, plus:
• Unlimited admission for up to 4 named individuals
The Newton — $250
Circle of Discovery Membership Benefits above, plus:
• Unlimited admission for up to 6 named individuals
• 4 “One Day” Passes
The Galileo — $500
Circle of Discovery Membership Benefits above, plus:
• Unlimited admission for up to 6 named individuals
• 8 “One Day” Passes
• 2 tickets to Annual Soiree
The Copernicus — $1,000
Circle of Discovery Membership Benefits above, plus:
• Unlimited admission for up to 6 named individuals
• 25 “One-Day” passes to use or share
• $100 donation to educational scholarship fund
• 4 tickets to Annual Soiree
Basic Members and Circle of Discovery Members
will receive the Science and Discovery Center’s
e-Newsletter and e-Blasts about upcoming events.
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Memberships are valid for one year from the date of purchase. Two
membership cards per family will be issued in the primary adult members’
names. Membership cards will list all named members. Children under 14
must be accompanied at all times by an adult. Guest passes are for general
admission only and do not include areas that require an additional admission
ticket. Guest passes are one-time use only. Free admission does not apply
when a member visits as part of a field trip or planned group activity.
Membership privileges are non-transferable, non-refundable, and nonreturnable. Benefits subject to change.
$79
$125
$250
$500
$1,000
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Names on Membership Cards
List 4 names total for Basic and Einstein levels
List 6 names total for Newton, Galileo or Copernicus levels
List First Names and Last Names:
1.
Ms./Mrs.
 Adult
Mr./Dr. __________________________________  Child
_______________________________________
2. Ms./Mrs.
 Adult
Mr./Dr. __________________________________  Child
_______________________________________
3. Ms./Mrs.
 Adult
Mr./Dr. __________________________________  Child
_______________________________________
4. Ms./Mrs.
 Adult
Mr./Dr. __________________________________  Child
_______________________________________
5. Ms./Mrs.
 Adult
Mr./Dr. __________________________________  Child
_______________________________________
6. Ms./Mrs.
 Adult
Mr./Dr. __________________________________  Child
_______________________________________
Mailing Information
Name
Address
City
Phone
Email
Employer
Amount Enclosed $
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 Check #
DOB
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 Check if this is a gift
State
Zip
 Visa  MC  AMEX
Credit Card
Expiration Date
Signature
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For more information
Please call (850) 769-6128 or visit our website at:
www.ScienceAndDiscoveryCenter.org
Mail completed membership forms to:
Science & Discovery Center of Northwest Florida
308 Airport Road, Panama City, FL 32405
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For Office Use Only
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