Online Membership Form

Type of Membership: Renewal New Membership Gift Membership

Renewals Provide Current Membership Number:

Choose Your Salutation: Mr. Drs. Mrs. Dr. Miss Ms. Mr. and Mrs.

Member First Name: Spouse's First Name:

Member Last Name:

Address:

City: State: Enter State Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Home Phone: Business Phone:

Email:

Optional Nanny or Babysitter Name ($15 extra):

If this is a Gift Membership, fill in your information as well:

Choose Your Salutation: Mr. Drs. Mrs. Dr. Miss Ms. Mr. and Mrs.

Gift From (first & last name):

Address:

City: State: Enter State Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Home Phone:

Email:

Send Gift Certificate to:

OR

Send initial membership packet to:

Send annual renewal notice to:

Member Category Purchasing:
Basic (2 people) $60
Family I (4 people) $80
Family II (6 people) $95*
Supporter $150
Sponsor $300
Benefactor $500
Patron $1,000

Add Nanny or Babysitter $15 extra

*If there are more than 6 people in your family, additional people may be added to your Family II membership for $10 each. Let us know how many additional people you want to add: 0 1 2 3 4 5 6 7 8 9 10

Credit Card: VISA MasterCard Discover

Name on Credit Card:

Credit Card Expiration Date (xx/xx): Credit Card Account Number:

Your credit card number will be hidden as you type it into the box. This is a password box allowing visitors to enter confidential information without other people viewing the information. The Children's Museum of Memphis makes every effort to protect your credit card information.
 

Comments, Questions or Suggestions:

By hitting the submit button below, you are authorizing The Children's Museum of Memphis to charge the credit card above with the amount of your membership purchase.