Ukrainian Museum Membership Form

T h e U k r a i n i a n M u s e u m
222 East 6th Street (bet. 2nd and 3rd Aves.) New York, NY 10003 212-228-0110
Wed. thru Sun. 11:30 am - 5:00 pm e-mail: info@UkrainianMuseum.org

THE UKRAINIAN MUSEUM MEMBERSHIP APPLICATION
Print this form directly from your browser, and mail to the address above.

Please check one:

______New Member ______Renewal

Categories of Membership (per year). Please check desired category:

______$ 50.00 Individual

______$100.00 Sustaining Individual

______$15.00 Student

______$125.00 Family

______$150.00 Sustaining Family

______$20.00 Senior (65+)

______$250.00 Institutional

______$7500.00 Permanent Membership

Name:

Address:

City:
State:
Zip:

E-mail:

Telephone: ( )
Date:

Enclosed is my check for membership dues (U.S. dollars) $_______________.

To present a gift membership, please fill out the above form in the person's name, entering the giver's name below:

______________________________________________

If your company has a Matching Gift Program, kindly check with the personnel office for appropriate forms and utilize them when making a donation to the Museum. Gift contributions are tax deductible to the extent allowed by the law.

Please make checks payable to:

The Ukrainian Museum
222 East 6th Street
New York, NY 10003
Telephone (212) 228-0110
FAX: 212 228-1947
info@ukrainianmuseum.org
www.ukrainianmuseum.org