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
Wed. thru Sun. 11:30 am - 5:00 pm (212) 228-0110 * e-mail: info@UkrainianMuseum.org

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

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

______$40.00 Individual

______$10.00 Student

______$15.00 Senior (65+)

______$75.00 Family

______$100.00 Sustaining

______$150.00 Institutional Members

______$7500.00 Sponsor

Name:

Address:

City:
State:
Zip:

E-mail:

Telephone: ( )
Date:

Enclosed is my check for membership dues (US 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 Sixth Street
New York, NY 10003
Telephone (212) 228-0110
FAX: 212 228-1947
E-mail: info@ukrainianmuseum.org
www.ukrainianmuseum.org