DEBENCE ANTIQUE MUSIC WORLD

DeBence Antique Music World is a 501(c)(3) non-profit organization. We’d love to
have you become a member of the DeBence Antique Music World family.
All memberships/donations help to keep the museum open to the public and keep the
instruments in working order.

Click HERE for a printer friendly copy of this form and return with your check to:

DeBence Antique Music World

1261 Liberty St

Franklin PA 16323

Yes, include me in the DeBence Antique Music World sustaining membership family.
Many hands make light work. Together we can keep the music playing.
Enclosed is my tax deductible donation via check or credit card.

	Individual Membership (Free admissions for one year) This pays the utility bill for 38 hours	$35
	Family Membership (Admission for up to 4 family members for one year) This pays our mailing costs for 25 days	$50
	Edison Club Membership (Admission for up to 4 for one year plus one CD) This pays for 60 days of supplies to repair machines (We do the work ourselves)	$100
	Music Box Club (Admission for up to 4 for one year plus two CD's) This pays the interest on the elevator loan for 28 days	$250
	Nickelodeon Club (Admission for up to 6 for one year plus two CD's) This pays for 48 days of insurance	$500
	Calliope Club (Admission for up to 6 for one year plus special benefits) This pays for the security system for one year	$1,000

Donation in other amounts will be gratefully accepted.

Name ______________________________________________________

Address ____________________________________________________

City ___________________________ State ___________ Zip ________

Phone email _______________________

Card Type (Circle one) M/C or Visa ____Card Number__________________

Expiration Date _______ Cardholder please sign here___________________

Security Code (from back of card) _________________________________