DuPage Children's Museum Membership Application

MEMBERSHIP INFORMATION *Required information

Membership Type

New Membership
Renewal - Please enter member number

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
Family -
         1 yr. at $88
Grandparent -
         1 yr. at $78
Child -
         1 yr. at $65
Educator -
         1 yr. at $49

I am a Licensed Daycare Provider

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 Educator or 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 $35

Extra Adult Option

NOTE: This option not available on Educator or 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 $20
Two Extra Adults Option - Additional $40

Additional Adult Name:

Second Additional Adult Name:

Educator Upgrade for Family, Grandparent or ACM Adventurer Membership

NOTE: This option not available on Educator or Child Memberships

Educator Upgrade adds the Educator Benefits to one member on a Family, Grandparent or ACM Adventurer Membership.

Educator Upgrade - Additional $10

Apply Educator Benefits to Member Name1
Apply Educator Benefits to Member Name2

Educator Upgrade Applies to this Member:

Gift Giver's Information

First Name:
Last Name:
Address:
City:
State:	Zip Code:
Phone:

Send Gift Certificate to me
Send Gift Certificate to the recipient

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.