Prairie Aviation Museum
Membership Application
Name ____________________________________________________________________
Address ___________________________________________________________________
City __________________________________________________________ State __________
ZIP _________________
Home Phone (____ )________________________________
Cell (_____)_____________________________________
Email ___________________________________________________________
YES I want to help preserve aviation history
__________ I would like to contribute $____________________
Please enroll me as a member in the following classifications
__________ Individual ($30 annually)
__________ Youth under age 18 ($15 annually)
__________ Family – 1 or 2 adults & children 17 and under living at the same address ($60 annually)
__________ Volunteers are the backbone of the Museum. I would like to volunteer some of my spare time to Museums projects
__________ Please contact me concerning artifacts that I would like to donate
Method of Payment
______ Check (payable to Prairie Aviation Museum)
______ Visa ______ MasterCard
Card # __ __ __ __ – __ __ __ __ – __ __ __ __ – __ __ __ __ CVV __ __ __
Expiration Date Mo _____________ Yr ___________
Signature ________________________________________________________
Date _______________________________
Due to privacy laws, this information will not be used by anyone outside of the Museum.
Prairie Aviation Museum is a not-for-profit charitable organization under 501(c)(3) of the Federal Internal Revenue Code. Donations to the Museum may qualify as tax-deductible gifts.
After completing this form, please mail it to:
Prairie Aviation Museum
2929 East Empire Street
Bloomington, IL 61704
Membership form 031419