Sigma Xi Automatic Membership Dues Payment Authorization

By submitting this form you are authorizing Sigma Xi to charge your credit/debit card for your annual membership dues, local chapter dues (if selected), and American Scientist print and digital editions (if selected) in May of every year. Automatic dues payment through your designated credit/debit card will continue each year thereafter, until and unless you notify us to stop. An e-mail notification of the dues deduction will be sent to you after your credit/debit card has been charged. In the event that a charge is declined, your account information will be removed from the automatic payment service until new information is provided. Unemployed members are not eligible for the automatic payment option.

You may cancel your participation in the automatic dues program by contacting the Finance Department at 800-243-6534 or 919-549-4691 or by e-mail to finance@sigmaxi.org.

Is this a new request to sign up for automatic dues payment, or are you updating your existing automatic dues payment information?: *

I'm signing up for automatic dues payment for the first time.

I'm updating my existing automatic dues payment information.

First Name: *

Last Name: *

Sigma Xi Membership #:
(if known)

Email: *

Phone: *

Emeritus Status

Emeritus dues are a reduced membership rate of $65.00 per year and are available to any member that meets all of the following 3 criteria:

1.) 65 years of age or older

2.) Retired

3.) Inducted into Sigma Xi at least 30 years ago.

Request for emeritus status:

I meet all 3 of the qualifications listed above and wish to apply for emeritus status.

Automatic Dues Payment Authorization

Annual Membership Dues:
(Click here to view the membership rates.) *

I wish to have my annual Sigma Xi membership dues automatically charged to my credit/debit card each year in May.

Local Chapter Dues (if any):
(Click here to see the local dues for your chapter.) *

Yes, I wish to have my local Sigma Xi chapter dues automatically charged to my credit/debit card each year in May.

No, do not charge my local Sigma Xi chapter dues automatically to my credit/debit card each year in May.

Select Your Desired American Scientist Magazine Format: *

Print Edition (included with membership dues.)

Digital Edition (included with membership dues.)

Print & Digital Editions ($20.00 additional annual charge.)

I do not wish to receive American Scientist magazine in any format.

American Scientist Print & Digital Editions $20.00 Charge Authorization: *

I authorize an additional $20.00 fee to be charged to my credit/debit card each year in May in order to receive both the print and digital editions of American Scientist magazine.

Membership Dues Automatic Payment Authorization: *

I hereby authorize Sigma Xi to automatically charge my credit/debit card in May of each year in the amount of my annual membership dues. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Sigma Xi in writing of any changes in my account information or termination of this authorization at least 15 days in advance. I certify that I am an authorized user of this credit/debit card and will not dispute these scheduled transactions, so long as the transactions correspond to the terms indicated in this authorization form.

Membership Dues Automatic Payment Authorization: *

I hereby authorize Sigma Xi to automatically charge my credit/debit card in May of each year in the amount of my annual membership dues plus my local chapter dues. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Sigma Xi in writing of any changes in my account information or termination of this authorization at least 15 days in advance. I certify that I am an authorized user of this credit/debit card and will not dispute these scheduled transactions, so long as the transactions correspond to the terms indicated in this authorization form.

Membership Dues Automatic Payment Authorization: *

I hereby authorize Sigma Xi to automatically charge my credit/debit card in May of each year in the amount of my annual membership dues plus $20.00 to receive both print and digital editions of American Scientist magazine. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Sigma Xi in writing of any changes in my account information or termination of this authorization at least 15 days in advance. I certify that I am an authorized user of this credit/debit card and will not dispute these scheduled transactions, so long as the transactions correspond to the terms indicated in this authorization form.

Membership Dues Automatic Payment Authorization: *

I hereby authorize Sigma Xi to automatically charge my credit/debit card in May of each year in the amount of my annual membership dues, plus my local chapter dues, plus $20.00 to receive both print and digital editions of American Scientist magazine. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Sigma Xi in writing of any changes in my account information or termination of this authorization at least 15 days in advance. I certify that I am an authorized user of this credit/debit card and will not dispute these scheduled transactions, so long as the transactions correspond to the terms indicated in this authorization form.

Payment Information

Please fill out either the credit/debit card information below to authorize Sigma Xi to charge your account with the dues amount(s) each year in May.

Credit/Debit Card Type: *

Visa	MasterCard
Discover	American Express

Card Number:
(Do not enter dashes or spaces) *

Expiration Month: *

Expiration Year: *

3 or 4 Digit Security Code: *

Name on Card: *

Card Billing Address: *

Card Billing City: *

Card Billing State: *

Card Billing Zip/Postal Code: *

Review your information carefully before clicking the 'Submit' button below.