Gift Membership Form

Chesapeake Bay Maritime Museum
P.O. Box 636bullet2.gif (61 bytes)St. Michaelsbullet2.gif (61 bytes)Marylandbullet2.gif (61 bytes)21663-0636bullet2.gif (61 bytes)(410) 745-2916

Please complete the below membership application. Our server has a Secure Socket Layer (SSL) that enables you to submit your membership application on-line using a credit card. However, in the event you would rather FAX or mail it, click on the small printer icon on your browser instead of the submit button. Be sure to fill out the application completely. Our FAX number is (410) 745-6088.

$10 off for a membership gift!*

My Name:
Mailing Address:
City:
State: Zip:
Day Phone:

Evening:

Email Address:

 

Gift Recipient Name:
Mailing Address:
City:
State: Zip:
Day Phone:

Evening:

Email Address:
Gift Recipient Name:
Mailing Address:
City:
State: Zip:
Day Phone:

Evening:

Email Address:

 

 

 

 

 

 

Please select the type of Gift Membership: (prices below reflect gift discount)

Reduced prices for NEW members only

Individual

$55 $45
Per Year		 Supporter $200 $190
Per Year
Family $70 $60
Per Year		 Benefactor $500 Per Year
Contributor $100 $90
Per Year		 Sustaining $1,000 Per Year
Life $2,500.00 One Time

 

Method of payment  (check appropriate box)

Check or Money Order Enclosed: (Make checks payable to CBMM)
VISA MasterCard Discover
Name as it appears on the credit card:
Card Number: Exp. Date:

Signature (for FAX or mail in application)

Enter any comments in the space provided below:

Public Disclosure 

A copy of the current financial statements is available on request by writing or calling the Chesapeake Bay Maritime Museum, P.O. Box 636, St. Michaels, MD 21663; 410-745-2916.  For the cost of copies and postage, documents and information are available from the Secretary of State, Maryland.

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