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NWHM Printable Charter Membership Form

Join As:


___Charter Member     ___Renew Membership    ___Gift Membership


___$25 (Student/Young Professional)    ___$35     ___$50     ___$100     ___$250    ___$500     ___$1,000 (Leadership Circle)

   ___$10,000 (President's Advisory Council)    ___Other $
_____


To see Membership Benefits, click here.         To donate online, click here.

or fill out the form below and mail it with your check (payable to NWHM) or credit card information to:

National Women's History Museum
205 S. Whiting Street, Suite 254
Alexandria, VA 22304


___My check for $_____ is enclosed.

___Please bill my American Express / MasterCard / Visa / Discover credit card:


Account #_________________________________________ Exp. date_________


Signature __________________________________________________________


My information:


Mrs. /  Ms. /  Miss /  Mr. /  Dr.

Name _____________________________________________________________


Address ___________________________________________________________


City __________________________ State ________ Zip_____________


Home Phone ___________________________    E-mail _____________________________________


___This is a gift for:


Mrs. /  Ms. /  Miss /  Mr. /  Dr.

Name _____________________________________________________________


Address ___________________________________________________________


City __________________________ State ________ Zip_____________


Home Phone ___________________________    E-mail _____________________________________