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Membership Application

ourstory@aamcleveland.org

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African American Museum Cleveland, Ohio Application for Membership

Please check type of application.

New Renewal

Please check if this is a new mailing address.

New Address

Please enter your full name

Name:

Please enter your street address

Street Address:

Please enter your city, town or village

City:

Please enter your state

State:

Please enter your zip code

Zip Code:

Please enter your telephone number

Phone # include area code:

Please enter your return e-mail address (optional yet preferred)

E-mail Address:

Please enter today's date

Date:

Please select a membership level

Membership Levels

PERSONAL

Student	$10.00
Senior Citizen	$15.00
Individual	$25.00
Ebony Family	$50.00
Pyramid	$100.00
Diamond Pyramid	$250.00
Golden Pyramid	$500.00
Dynasty	$1000.00

CHURCH, ORGANIZATION, SMALL BUSINESS

Pyramid	$100.00
Diamond Pyramid	$250.00
Golden Pyramid	$500.00

CORPORATE

Dynasty	$1000.00
Diamond Dynasty	$2500.00
Golden Dynasty	$5000.00

Please complete and print the order form. Enclose check or money order made payable to African American Museum and mail to:

African American Museum

1765 Crawford Road

Cleveland, Ohio 44106

Thank You For Your Support

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For Information Call African American Museum at. 216 791 1700 or email
ourstory@aamcleveland.org

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