First Name

Last Name

Address (line 1)

Address (line 2)

City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NE NH NJ NM NY NC ND NV OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip

Home Phone Mobile Phone

e-Mail Address

Gifts of Cash

Amount of Donation: $

Honor Wall Tile

$100 3×6 Inch Tile: Quantity

Special honoree, organization, corporation or other message to appear on tile:
(Maximum of 14 Characters per line, and up to 2 lines)

Line 1

Line 2

$500 6×6 Inch Tile: Quantity

Special honoree, organization, corporation or other message to appear on tile:
(Maximum of 14 Characters per line, and up to 2 lines)

Line 1

Line 2

$1000 12×12 Inch Tile: Quantity

Special honoree, organization, corporation or other message to appear on tile:
(Maximum of 24 Characters per line, and up to 2 lines)

Line 1

Line 2



Name-a-Chair

$500 Theater or Briefing Room Seat Sponsorship: Quantity

$1000 Mission Control Room Seat Sponsorship with Name: Quantity

Special honoree, organization, corporation or other name to appear on seat:
(Mission Control Room Seat Only. Maximum of 14 Characters per line, and up to 2 lines)

Line 1

Line 2

The Challenger Space Center requires credit card payment only for online purchases.
Please select one of the following cards and fill in the appropriate information.

Card Holder

Account Number

Expiration Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 2004 2005 2006 2007 2008 2009 2010