Membership Form – print and complete

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