Membership Form

Please fill out the form below to sign up for a Membership.

Name

First Name*

Last Name*

Address

Street 1*

Street 2

City*

State*

Zip*

Phone

Required* --

Required*

Type of Membership
Required*

	Renewal
	New Member

Membership Level
Required*

If you wish to purchase more than one membership, please fill out the form for each membership. Thank you.

Please keep me informed about the following:

	Adult & Children’s Classes
	Artist Opportunities
	Planned Giving Opportunities
	Yes! I would like to receive special emails from the Massillon Museum.

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