Individual Membership (includes admission for 1 year)	$35
	Family Membership (Admission for up to 4 family members for 1 year)	$50
	Edison Club Membership (Admission for up to 4 for 1 year + special gift)	$100
	Music Box Club (As above PLUS DeBence cassette tape)	$250
	Nickelodeon Club (As above PLUS DeBence CD)	$500
	Calliope Club (As above plus framed DeBence print)	$1,000
	Corporate Membership	$1,000
	Maintain the Melody Fund (instrument repair/restoration)	______
	Welcome to Yesteryear Fund (Operations and renovation of building)	______
	Other gift	______
	Memorial/Honorarium	______
	(Please include name of honoree and name of person to receive acknowledgement if other than yourself).

Name _____________________________________________________________

Address ___________________________________________________________

City ______________________________ State ________________ Zip _______