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
|
¬ $ 100.00 Friend*
¬ $ 500.00 Sponsor*
¬ $1,000.00 Patron*
¬ $2,500.00 Benefactor*
¬ $5,000.00+ Cornerstone*
|
* Founding memberships are a
one-time gift.
¬ Visa ¬ MasterCard ¬ Check Enclosed $ ______________
Card Number: __________________________________ Exp. Date: ____/____
Amount: $ __________ Name on Card: _________________________________
Signature: ________________________________________
