You must have JavaScript enabled to use this form. Membership Type Gift Membership will be given in your name to individual(s) of your choice specified below. New and Renewal Membership will be purchased for yourself. Membership Type New Renew Gift Membership Membership Level Membership Level Coyote Pack (FREE) Individual ($50) Dual ($85) Family ($75) Associate Level ($150) Benefactor ($1,000 and above) please contact miranda.canseco@csusb.edu for further assisstance Member Information Names Title Title - None -MissMsMrMrsDrOther… Enter other… First Last Additional Names - None -012345 Additional First Name 1 Additional Last Name 1 Additional First Name 2 Additional Last Name 2 Additional First Name 3 Additional Last Name 3 Additional First Name 4 Additional Last Name 4 Additional First Name 5 Additional Last Name 5 address information Email Phone Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code How did you hear about Friends of RAFFMA? Options RAFFMA Website Mailing Museum Front Desk CSUSB Faculty/Staff Current RAFFMA Member Other… Enter other…