I would like to become a member of the Children's Museum
in the _________________________________________ category.
Please list all the names to be included for membership. All membership cards are nontransferable and must be presented for admission.
Name: _______________________________________________
Name: _______________________________________________
Name: _______________________________________________
Name: _______________________________________________
Name: _______________________________________________
Name: _______________________________________________
Address: _____________________________________________
____________________________________________________
Telephone Number: _____________________________________
Membership Level Fee $__________________________________
Additional Donation (Optional) $_____________________________
Total amount enclosed $__________________________________
A Gift from _____________________________________________
For Contributing Membership Categories, please select:
A membership card for free admission _____
A certificate to display in the company office or at home _____
Make checks payable to:
The Children's Museum, Inc.
2 West Seventh Street
Bloomsburg, PA 17815
570-389-9206 |