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MacBride Museum Membership Application

Please indicate:

• Have you been a resident of the Yuko n for the past 6 Months? Yes__ No___
• Are you 18 years of age or older? Yes______ No_______

Your membership will be for a period of 12 months from the time that it is approved by the Board of Trustees.

Name (s): _______________________________________________________

Children's names: ________________________________________________

(for family membership only, children under 18)

Address: ________________________________________________________

City: __________________ Terr/Prov: _________ Postal Code: __________

Telephone: ____________________________

email: __________________________________________

Type of Membership Renewal______New_______

___ Individual ($20)

___ Senior ($15)

___ Family ($30) – (one vote per membership)

___ Association ($50) – (one vote per membership)

___ Corporate ($100) – (one vote per membership)

 Signature: ______________________ Date: ______________________

 DONATION

Please support your museum. We raise most of our own operating funds through admissions and museum shop revenues. Your donation will help offset increasing costs. Donations are tax deductible.

___ $25 ___ $50 ___ $100 or $________

Please make Cheques and money orders payable to MacBride Museum

___ Cheque ___ Cash ___ Money Order ___ Visa ___ Master Card

 Card Number ______________________________ Expiry Date ___________

 Thank you for your support

For office use

___c ____r ___ml ___tx Expiry Date_________________