Champaign County History Museum Membership Application

New MembershipRenewal

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Member Name (for Patron Level or higher)

First NameLast Name

My Products

Basic Member

10% off Gift Shop

$35.00 Quantity

Friend

All Basic Member benefits + Event Discounts, Free Copy of Historical Essays of Champaign County.

$50.00 Quantity

Patron

All Friend benefits + Invitation to History on the Town Member Appreciation Event

$100.00 Quantity

Historian

All Patron benefits + Free Holiday Ornament

$250.00 Quantity

Curator

All Historian benefits + Private tour of the museum

$500.00 Quantity

Cattle Bank Society

All Curator benefits + Special Recognition

$1,000.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Apple Pay

Google Pay