NAME:_______________________________________________

ADDRESS:____________________________________________

ADDRESS:____________________________________________

CITY:__________________________ STATE:___ ZIP:________

PHONE:_____________________________________________

EMAIL:______________________________________________

SEND ME OCCASIONAL EMAIL NOTICES OF EVENTS/ACTIVITIES:       YES______  NO______

INDIVIDUAL ($25)

FAMILY ($50)

SPONSOR ($100)

PATRON ($200)

BENEFACTOR ($1000)

 I would like to give the gift of membership to the following people:

NAME:_______________________________________________

ADDRESS:____________________________________________

CITY:__________________________ STATE:___ ZIP:________

MEMBERSHIP LEVEL:___________________________________

NAME:_______________________________________________

ADDRESS:____________________________________________

CITY:__________________________ STATE:___ ZIP:________

MEMBERSHIP LEVEL:___________________________________

I want to donate to the museum artifacts acquisition fund:

_____$10 _____$25 _____$50 _____$100 _____Other

I want to help in the following ways:
Museum Volunteer

Help with Robeson Remembers Project

Help with Historical Tours

Donate the following to the Museum

Loan the following to the Museum

I would like to suggest the following exhibit or program ideas: ________________________________