Coolspring Power Museum Membership Form |
Company Name: ____________________________________ |
Home Phone: ______________________ |
Name: ____________________________________ |
E-mail: ______________________ |
Street: ____________________________________ |
2nd E-Mail: ______________________ |
City: ____________________________________ |
Cell Phone: ______________________ |
State: ____________________________________ |
Work Phone: ______________________ |
Country (if other than USA): __________________ |
Fax: ______________________ |
ZIP code or International Code: _______________ | |
Today's Date (Month, Day, and Year):___________________________________ | |
Do you wish your name to be kept confidential? If you answer yes, your name will not be printed in the museum's Friends Directory: (Yes or No):_________ | |
Expertise/Occupation/Skill you could volunteer to the museum:___________________________________ | |
_______________________________________________________________________________________ |
Please check membership type: |
|
ANNUAL MEMBERSHIPS DUES | LIFE MEMBERSHIPS DUES - One Time Contribution |
_____ Annual Friend Dues - $30 |
_____ Patron $1,000 |
_____ Annual Family Friend Dues - $40 |
_____ Cornerstone Patron $5,000 - $9,999 |
_____ Endowment Patron $10,000 and up |
Membership Dues Amount from Above |
$ |
Additional Amount for the General Operating Fund |
$ |
Additional Amount for the M.A.N. Diesel Engine Fund |
$ |
Additional Amount for the Endowment Fund |
$ |
International Processing Fee* |
$ |
Other |
$ |
Total Enclosed |
$ |
Send with remittance to:
Coolspring Power Museum |
The official registration and financial information of Coolspring Power Museum may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement. |
*International Members: Please add a $15 fee to cover the fee our bank
charges
|
Copyright © by Coolspring Power Museum |