Name:__________________________________________________________

Mailing address:_________________________________________________________

                 City:_______________________________  State:________ Zip:_________

             E-mail:_______________________________    Phone:___________________

Amount enclosed:_____________________________

___For FOPMO membership   ____ For proposed Educational Center

Please send me a receipt (check)    ___Yes   ___No

Send $35 (or more), check made out to Friends of Pine Mountain Observatory to

              Pine Mountain Observatory
              Bend-Burns Star Route
              Bend, OR 97701