Sigma Xi Explorers Enrollment Form

Prefix: *

First Name: *

M.I.

Last Name: *

Suffix:

Daytime Phone #: *

Date of Birth (mm/dd/yyyy): *

Email Address:
(Sigma Xi does not share email addresses with outside parties) *

Gender (optional):

Ethnicity (optional):

Mailing Address

Country: *

Address Line 1: *

Address Line 2:

City: *

State:

State: *

Province: *

Zip Code: *

Education Information:

Name of School: *

Grade: *

Expected Graduation Year: *

Name of Recommending Teacher: *

Teacher's Phone: *

Teacher's Email: *

Areas of Interest: *

Is the applicant under the age of 18?: *

Yes

No

For Parent/Guardian/Legal Custodian:

I certify that I am the parent, guardian or legal custodian of the above applicant: *

Yes, I am the parent, guardian or legal custodian of the applicant listed above.

Name of Parent/Guardian/Legal Custodian: *

Parent/Guardian/Legal Custodian Phone: *

Parent/Guardian/Legal Custodian Email: *

American Scientist Magazine

Your Sigma Xi Explorer membership dues include one year of the digital version of American Scientist magazine. You may elect to instead receive the print version of American Scientist magazine for an additional $10.00 per year charge.
Please indicate which format of American Scientist magazine you'd prefer to receive:
*

Digital Version (Included)

Print Version (Additional $10.00 per year charge)

Future Sigma Xi Mailings

Please indicate your mailings preference: *

I consent to receive mailings from Sigma Xi and American Scientist magazine.

Please do not use my address for any marketing mailings. I understand that I will still receive mailings related to Sigma Xi Explorers.

Explorer Dues

Select Your Sigma Xi Explorer Dues Term: *

Sigma Xi Explorer Dues : 1 Year (US $25.00): (Expires on June 30, 2025)

Sigma Xi Explorer Dues : 2 Years (US $50.00): (Expires on June 30, 2026)

Sigma Xi Explorer Dues : 3 Years (US $75.00): (Expires on June 30, 2027)

Sigma Xi Explorer Dues : 4 Years (US $100.00): (Expires on June 30, 2028)

American Scientist Magazine - Print Version: *

American Scientist magazine print version: 1 year (US $10.00)

American Scientist Magazine - Print Version: *

American Scientist magazine print version: 2 years (US $20.00)

American Scientist Magazine - Print Version: *

American Scientist magazine print version: 3 years (US $30.00)

American Scientist Magazine - Print Version: *

American Scientist magazine print version: 4 years (US $40.00)

Current Total:

$0.00

Agriculture & Natural Resources	Mathematics & Computer Sciences
Biological Sciences	Engineering
Health Sciences	Physical & Earth Sciences
Social Sciences	Other