Become a Member:

Archives Partnership Trust
Membership Application Form

My information:

Name:
___________________________________________
Organization:
___________________________________________
Address:
___________________________________________
City:
___________________________________________
State:
___________________________________________
Zip:
___________________________________________
Country:
___________________________________________
Phone (Day):
___________________________________________
Phone (Evening):
___________________________________________
Email
___________________________________________

  Membership Levels
One Year
Two Years
  Friend/Family
 
$35
 
$65
  Senior Citizen/Student
 
$25
$45
  Non-Profit Organization
 
$19
$33
  Supporter
 
$100
$180
           

Please send a gift membership to:

Name:
___________________________________________
Address:
___________________________________________
City:
___________________________________________
State:
___________________________________________
Zip:
___________________________________________
Country:
___________________________________________
Phone (Day):
___________________________________________
Phone (Evening):
___________________________________________
Email
___________________________________________
This gift is:



:___________________
 
  Gift Membership Level
One Year
Two Years
  Friend/Family
$35

$65
  Senior Citizen/Student
$25

$45
  Supporter
$100
$180

I would like the gift card signed:

________________________________________

Renewal Notice: The renewal notice for the gift membership should be sent to:
.

Payment Information:

Membership Fee(s) $______________
Annual Appeal: (Optional) Please accept my unrestricted contribution. $______________
Postage: for delivery outside the United States only, add $20.00 $______________
TOTAL $______________

made payable to the Archives Partnership Trust.

ACCOUNT NUMBER:
________________________________
EXPIRATION DATE:
________________________________
CVV # (last 3 digits on card's signature line or, for AmEx, the 4 digits above card # ):
________________________________
SIGNATURE:
________________________________

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Print and mail this form to: Or fax form to:
Archives Partnership Trust
Cultural Education Center, Suite 9C49
Albany, NY 12230
518-473-7058