Membership Application

Welcome to the DuPage Children's MUSEUM On-Line Membership Application!
    

Prefer to send a check? Click here to download a pdf form. Print out the form,
fill it out completely and mail this form with your check to DCM at the following address:

DuPage Children's MUSEUM
301 N. Washington Street
Naperville, IL 60540
(630) 637-8000

MARCH MEMBERSHIP SALE!

ACM Adventurer Membership
REGULARLY $110 -
ON-SALE - $100

Offer ends March 31, 2010

MEMBERSHIP INFORMATION

Membership Type

New Membership
Renewal - Please enter member number

Level of Membership*

 

Contributing Memberships:
As a Contributing Member, you will enjoy additional benefits while helping to support the work of the DuPage Children' s Museum.


Benefactor -
         1 yr. at $1000
Children's Circle -
         1 yr. at $250

Regular Memberships:

ACM Adventurer -
         1 yr. at $110 $100
Family -
         1 yr. at $100
Grandparent -
         1 yr. at $100
Child -
         1 yr. at $75

I am a Licensed Daycare Provider

NOTE: Payment plan available for Family and Grandparent memberships. Call
630-637-8000 ext.0 for details.

Member Names*

First and Last Names of Adults
(or Child Name if purchasing a Child Membership)

Name 1: First Name 

Last Name 

Name 2: First Name 

Last Name 

Member Address*

Address: 

City: 

State: 

     Zip Code:

Member phone*

xxx-xxx-xxxx

Children in the Member Household and their Birthdays

NOTE: At a minimum, please provide the Month and Year for each child.

 

Name 1: 
Birthday:

Name 4: 
Birthday:

Name 2: 
Birthday:

Name 5: 
Birthday:

Name 3: 
Birthday:

Name 6: 
Birthday:

Deluxe Guest Option

NOTE: This option not available on Child Memberships.

Deluxe Guest Option includes admission for up to two guests with any visit to DCM for the length of the membership. ACM reciprocal privileges do not apply. Deluxe Guest Option Guests must be accompanied by Adult Member.

Deluxe Guest Option - Additional $40

Extra Adult Option

NOTE: This option not available on Child Memberships.

Extra Adult Option provides the capability to add one or two adult members to the membership. ACM reciprocal privileges do not apply.

Please check only one.

One Extra Adult Option - Additional $23
Two Extra Adults Option - Additional $46

Additional Adult Name:

Second Additional Adult Name:

Gift Giver's Information

NOTE: If this purchase is a Gift, please fill out this section.

 

First Name: 

Last Name: 

Address:

City:

State:

     Zip Code:

Phone:

Email:

Send Gift Certificate to me
Send Gift Certificate to the recipient. We will fill out your Gift Certificate for you.
Cancel Gift Certificate

Text for Certificate - EDIT AS DESIRED:
To:    
From:

Gift Message:

NOTE: The membership will be activated when the gift certificate is redeemed at the Museum.

Shipping Information

First Name: 

Last Name: 

Address:

City:

State:

     Zip Code:

 

Volunteer Opportunities

Please send me information on Volunteer Opportunities at the Museum

PAYMENT INFORMATION

Credit Card and Billing Address Information*

Card Type: Visa MasterCard Discover

Card Number (no dashes)

Expiration Date: Month Year

Copy from Membership Information Gift Giver Information

Name as it appears on card:

First Name (and MI):

Last Name:

Address:

City:

State:

     Zip Code:

Phone:

ex. xxx-xxx-xxxx

 
E-mail address (for transaction confirmation):

Additional Donation

$ (The Museum is a 501 (c)(3) nonprofit organization which must raise $4 of every $10 of its budget through donations each year.)

Total Amount to be Charged

This field is calculated for you based on the selections above.

$ U.S.