| __ Student $25 |
| __ Senior $30 (55+) |
| __ Individual $35 |
| __ Family $40 |
| __ Sustaining $75 |
| __ Contributor $100 |
| __ Donor $500 |
| __ Patron $1,000 |
| __ $5 - Add for international membership __ Check or money order enclosed: $__________________ __ Please charge to: ___ Mastercard ___ VISA ____ Discover Charge# __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Signature ______________________________________ Exp. Date _______ Member's Name ________________________________________________ Address ______________________________________________________ City __________________________________ State ______ Zip__________ Telephone ___________________ Email Address: ____________________ Is this a Gift Membership? If so, a card will be sent notifying the recipient of your gift. Please give information below: Gift Giver ______________________________________________________ Address _______________________________________________________ City __________________________________ State ______ Zip __________
Do you want to make an additional contribution to the
society? Contributions are tax deductible.
Cahokia Mounds Museum Society
|