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THE AMERICAN ASSOCIATION OF MUSEUMS
2 WEST 46TH STREET
NEW YORK, N. Y.

DATE [[dotted line]]

Application is hereby made for Membership in the class underlined below.

Individual Member ... For Individuals ... $5 annually
Life Member ... For Individuals ... $100 in one payment
Institution Member ... For Museums ... $10 or more annually

Name (Kindly print) [[dotted line]]
Address [[dotted line]]
[[dotted line]]
Official position (if connected with a museum) [[dotted line]]
[[dotted line]]
Check for $ [[dotted line]] is enclosed herewith payable to the Association.
^[[checkmark]]