Membership Form

Type of Membership:	Dual - $40 Family - $60 Family Plus - $80

Additional Donation to support the Museum:	Yes No



Primary Cardholder
Name:

Date of Birth:

Email:

Address 1:

Address 2:

City:	State: Zip:

Phone Number:



Secondary Cardholder
Name:

Date of Birth:

Email:



Additional Members

Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:
Name:	Date of Birth:



Method of Payment:	Check Credit Card Cash/Money Order You will be contacted for payment information and membership confirmation.

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