Membership Form

Name:

Address:

City: State: Zip Code:

Phone #: - -

E-Mail Address:

Type of Membership desired: (please select one)

Individual	$40
Family	$70
Family Plus	$95
Family Explorer	$125
Benefactor	$500
Grandparents	$80

 

 

 

 

# of Family members using membership

Method of Payment:
Cash
Check is Enclosed
Master Card/Visa
     Expiration Date:
     Credit Cart #:

Please make checks payable to:
Community Children's Museum

Mail to:
77 East Blackwell Street , Dover , NJ 07801

For additional information please call Jody Marcus at 973-366-9060.

www.communitychildrensmuseum.org