MEMBERSHIP APPLICATION FORM

To join, fax or mail this form with your payment to:  412.578.2465 / Carnegie Museums of Pittsburgh, Membership, 4400 Forbes Avenue, Pittsburgh, PA 15213. Or, feel free to bring this form to the Membership desk at any of our four museums. Please call Membership at 412.622.3314 if you have any questions.

Choose one of FIVE great values! Click on the link to learn more, then indicate your choice in "Payment Information." For questions about Membership Policies, please click here.

Premium
2 adults and 8 guests, plus a Caregiver

Family
2 adults and 4 children,
plus a Caregiver

Dual
2 adults OR 1 adult and 1 child/adult guest

Individual
1 adult

Senior (65+)
1 senior adult

Member Information

___ Mr. & Mrs.   ___ Mr.   ___ Ms.   ___ Dr.   ___ Other
 
_____________________________________________
Designated Adult Name on Membership (REQUIRED)

 ___ Mr. & Mrs.   ___ Mr.   ___ Ms.   ___ Dr.   ___ Other
 
_______________________________________________
Second Designated Adult Name
(OPTIONAL. For Premium, Family & Dual levels only.)

_______________________________________________
Designated Caregiver Name
(For Family & Premium levels only. Must be 18+.)


_______________________________________________
Street Address 
 
_______________________________________________
City/State/Zip
 
_______________________________________________   
Telephone   
   

_______________________________________________
Email Address (if you wish to receive email updates)

Payment Information
(Check one)

____ Premium   

$250

____ Family        

$150

____ Dual           

$100

____ Individual  

$75

____ Senior        

$50









Enter Total Amount:                 $________

____ Check payable to Carnegie Museums of Pittsburgh
 
____ Charge to: ____ VISA ____ MC ____ AMEX
 
_______________________________________________
 Account Number

______________________________
Expiration Date 

______________________________________________
Name on Card