Please be sure to print out a copy of this form before submitting it.  Make checks payable to CPAAM and mail to:

Central PA African American Museum

119 N. 10th Street

Reading, PA  19601

Membership includes free unlimited visits to the Museum.

Your annual membership dollars will assist in the growth and maintenance of our museum

Museum is a non-profit organization

FName:

M.I.

LName:

Address 2:

Address 1:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Web Page:

Email Address:

Annual Donation Amount $:

$35.00 Family Membership
$25.00 Discovery Member
$5.00   Student Member
$15.00 Friend of the Museum

Did you remember to print this form?