PRINTABLE MEMBERSHIP APPLICATION
Bluegrass Heritage Museum Membership Opportunities
M _________________________________________________________________________
Address____________________________________________________________________
City ____________________________________ State ________ Zip Code_____________
Phone Number _________________________ Email Address _________________________
Membership Level:
¬ $ 15.00 Senior (62 Yrs.+)
¬ $ 20.00 Individual
¬ $ 50.00 Family (Spouse & Children)
¬ $ 250.00 Sustaining
Founding Memberships * Founding memberships are a one-time gift.
¬ $ 100.00 Friend*
¬ $ 500.00 Sponsor*
¬ $1,000.00 Patron*
¬ $2,500.00 Benefactor*
¬ $5,000.00+ Cornerstone*
¬ Visa ¬ MasterCard ¬ Check Enclosed $ ______________
Card Number: __________________________________ Exp. Date: ____/____
Amount: $ __________ Name on Card: _________________________________
Signature: ________________________________________
Bluegrass Heritage Museum
P. O. Box 147
Winchester, KY 40392-0147