Please print this page, fill out the appropriate information and send to:
Southeast Museum 67 Main Street Brewster, NY 10509

Membership Application

 Sr. Citizen/Student $15
 Individual $25
 Family $35
 Friend $50
 Contributor $100
 Sponsor $250
 Supporter $500

I would like to make an additional contribution of $__________.

I am unable to join the Museum at this time, but would like to make a contribution of $__________.


· Name: ______________________________


· Address:____________________________

____________________________________

· City State Zip:________________________

____________________________________

· Phone: (day)__________________________

(eve) ________________________________



· Employer: ____________________________


· Address: ____________________________

____________________________________


Does your company match contributions?
 Yes        No

If a gift membership, card should read:






Please make checks payable to Southeast Museum.

All donations to the Southeast Museum are tax deductible to the extent provided by law.