THE UKRAINIAN MUSEUM MEMBERSHIP APPLICATION
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Categories of Membership (per year). Please check desired category

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: