KidsWork Children's Museum

Membership Form

Membership Type

Grandparent Membership ($150.00)

Family Membership ($190.00)

Additional Caregiver ($40.00)

C.L.I.M.B. Membership ($225.00)

Is Membership a Gift?

YES

Purchaser Contact Information

Name:

Phone Number:

Member Contact Information

Member 1 Name:
Member 2 Name:

Phone Number:

Address:

City:

State:

Zip Code:

Select if membership card should be mailed to above address.

Select if membership card will be picked up AT MUSEUM.

Email Address:

Child Name: *

Child Birthday: *