Membership Application Form

NOTE:  The membership year runs from January 1st through December 31st.  Dues for individuals, institutions or businesses joining after July 1st are prorated.  If joining after July 1st, click here for the prorated fee structure.

Instructions: Print out this page, complete it and mail, along with check to Michigan Museums Association. If paying by credit card, you may fax to 517-482-7997.

Fees (check one)
  Individual  
Student
$20
Staff of Member Organization
$25
Individual
$30
Contributing
$50
Sustaining
$100
Patron
$500
  Institution (fees based on budget)  
$0 - $25,000
$25
$25,001 - $100,000
$50
$100,001 - $250,000
$75
$250,001 - $500,000
$100
$500,001 - $1 Million
$200
$1 Million - $2.5 Million
$300
$2.5 Million - up
$400
Business
Contributor
$100
Associate
$500
Sponsor
$1,000

Member Name _________________________________________

New              Renewal

Institution Name ______________________________________

Address _____________________________________________

City/State/Zip _________________________________________

Phone/Fax ___________________________________________

Email/Web ___________________________________________


Amount Enclosed $____________________


MAKE CHECKS PAYABLE TO:
 Michigan Museums Association

RETURN TO:
MMA Membership
PO Box 10067
Lansing, MI 48901-0067

OR

Pay by Credit Card and Fax
Card Type (circle one) VISA MC DEBIT (w/Visa or MC logo)

Expiration Date ________ CID# (4 digits after sig. on card) ________
Number & Street of Credit Card Billing Address _________________

Cardholder Signature ____________________________________