NAME: Mr. Ms. Mrs.

City: State: Zip code:

Telephone:  Fax:   Email:

BUSINESS: (optional) Organization:

Title: Address:

City: State: Zip code:

Telephone:  Fax:   Email:

Please indicate your preferred mailing address:     Home  Business

In case of emergency, contact Telephone:

.

FOR OUR MEMBERSHIP PROFILE, PLEASE INDICATE:

Have you previously been a member?   Yes   No    If yes, when?

Date of birth:     for junior and student memberships only.

I hereby apply for membership in the Mechanics' Institute and I agree to abide by its rules.

Your signature: Date:

Membership categories and dues:
      Individual, regular (age 22 and over)   $ 95 per year
      Student (age 35 and under)   $ 35 per year
            (need current ID and copy of class schedule for college/university students)
      Family  $ 150 per year
           (defined by 2 adults and 2 children under the age of 22, sharing the same residence/address)  
      Associate   $ 250 per year
      Patron   $ 500 per year
      Benefactor   $ 1,000 per year
      Life membership   $ 1,600
      One-year subscription to monthly Library newsletter "The Stereopticon"  $ 5.00 (regular mail)
      One-year subscription to bi-monthly Mechanics' Institute Calendar  $ 5.00  (regular mail)
      Please add my email address to the MI listserv to receive the Calendar electronically - FREE 
     
TOTAL DUES AND FEES:      

PAYMENT OPTIONS:
The Mechanics' Institute accepts VISA, Mastercard, personal checks, money orders and cash for payment of membership dues. Please make checks payable to:  Mechanics' Institute.

WE WELCOME VOLUNTEERS!

Please let us know if you would like to volunteer your time in any of the following departments:

       Library      Events       Chess Room      Fundraising  

Please note any other areas of interest or expertise: