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Archives Partnership Trust
Membership Application Form

Yes! I want to join (or renew my membership in) the Archives Partnership Trust.

Yes! I want to give a gift membership to the Archives Partnership Trust.

Yes! I want to both join (or renew my membership in) the Archives Partnership Trust AND give a gift membership.

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: for a birthday for a marriage in honor of other (please specify):___________________

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: me my gift recipient.

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	$______________

Enclosed is a check made payable to the Archives Partnership Trust.

Please charge my: Visa MasterCard Discover AMEX

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

Occasionally we share our mailing list with other non-profit cultural organizations. If you prefer not to receive such mailings, please check the box.

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