Credit Card Authorization / Refund Form

CONTACT INFORMATION (Name of Registrant if related to a meeting)

First Name *

Last Name *

Middle Initial

Affiliation / Institution

Please enter your AAS ID# or Invoice # if known.

Primary Email Address *

Pronoun

Phone Number

PAYMENT OR REFUND DETAIL

What's needed? *

Refund request

Charge on an alternate card

Payment / Renewal

Membership, Meetings, a Donation, or Shop@Sky? *

Let us know if your request is related to an AAS meeting or something else. *

Briefly explain your request.

If this form is in support of student activities, please enter the name(s) of the supported student(s) here.

AGREEMENT AND PAYMENT / CREDIT INFORMATION

I authorize and acknowledge that all of the aforementioned charges or credits will be processed to my credit card for the above mentioned persons or purchase items.

Authorized amount to charge or credit: *

Credit Card Type *

Name on Card *

Credit Card Number *

Expiration Date *

CSC: * 🛈

Signature *

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