Pennsylvania Heritage Membership Sale

FAMILY MEMBERSHIP: $75

INDIVIDUAL MEMBERSHIP: $55

HERITAGE SUBSCRIPTION: $35

This form is for Gift Memberships ONLY

This membership is

New
Renewal

Enter name of purchaser:

Address of Purchaser

Where to send the gift membership:

To the below address
Send it to me and I will send out

Mail future renewal notices to:

Purchaser
Gift Recipient

Name

Prefix

First Name *

Last Name *

Suffix

Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Phone

Membership

PA Heritage Foundation Membership
State Museum of PA Membership

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Member Type

Family Membership
Individual Membership
Heritage Subsciption

Second Adult Name

Second Adult Name and # of Children are for Family and Contributor Memberships

Prefix

First Name

Last Name

Suffix

# of Children for Family Membership:

Select a Payment Method

Credit Card
Bank Account

Cardholder Name (Required)

Credit Card # (Required)

Expiration Date (Required)

Security Code (Required)

cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

Cover the fee associated with this online transaction?

Yes, I will pay an additional {transaction_fee} to cover the cost of this transaction.

Cover the fee associated with this online transaction?

Account Holder

First Name

Last Name

Account Type

Checking
Savings

Account Number (Required)

Routing Number (Required)

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Additional Comments

Membership

Gift Membership Form

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