Membership Application

MEMBERSHIP LEVELS

INDIVIDUAL ---------------------------------------------$25
Benefits as listed above

FAMILY ---------------------------------------------------$45
Benefits for two adults and all children under age 18

SUPPORTER -------------------------------------------$75
Family benefits plus four additional one-day passes to the exhibit galleries in the St. Louis County Heritage & Arts Center

CORNERSTONE -----------------------------$125-$249
Supporter benefits plus SLCHS t-shirt

BENEFACTOR --------------------------------$250-$499
Cornerstone benefits plus a free Family membership to give as a gift in your name

PATRON ----------------------------------------$500-$999 Benefactor benefits plus a complimentary item from the Society’s gift catalog

DIRECTORS’ CIRCLE ---------------$1000 and over
Patron benefits and an invitation to the annual Directors’ Brunch

Membership Registration

Name(s)_________________________________________
Address_________________________________________
City/State/Zip_____________________________________
Phone___________________________________________
Email___________________________________________
Children’s Names (if applicable)______________________
________________________________________________

Please indicate your preferred membership.
Individual, $25             Family, $45
Supporter, $75             Cornerstone, $125-$249
Benefactor, $250-$499  Patron, $500-$999
Directors’ Circle $1,000 and over

Amount Enclosed: $________________________

Check enclosed (Payable to SLCHS)
Please bill my credit card for $___________________
MasterCard Visa
Name of cardholder: _____________________________
Card number: ________-________-________-________
Expiration Date: ______________________
Signature: _____________________________________