Application for Membership

The USFFM invites YOU to join.

MEMBERSHIP FORM

Full Name:__________________________________________________________

Address:___________________________________________________________

Phone: ____________________________________________________________

Cell:________________________________Fax:___________________________

E-Mail:____________________________________________________________

This is my Home ___ Office ____ address.

Membership Categories:

Museums $100

Museum Associations $150

Individual $ 75

Under 36 years of age $ 45

Family $100

Supporter $ 250

Patron $ 500

Benefactor $1000

Corporate $2000

Total Amount: $____________

The USFFM is a 501 ( c) (3) charitable organization for US income tax purposes.

Checks should be made payable to USFFM and sent with a copy of this form to:

USFFM

Suite 1200

1050 Connecticut Avenue, NW

Washington, DC 20036-5137

.