Please indicate one of the following:
New membership Renewal

(Please print clearly)
Name: _______________________________________________________________________

Title: _________________________________________________________________________

Institution: ____________________________________________________________________

Address: _____________________________________________________________________

City: ______________________ State: _______________ Zip: __________________________

Telephone: ______________________________Fax: __________________________________

E-mail: _______________________________________________________________________

Website: _______________________________________________________________________

Institutional Discipline
This information is important for NEMA's networking services. Please check no more than two:

Agricultural
Anthropology/Ethnology
Aquarium
Art
Children's Museum
College and University

Culturally Specific
Decorative Arts
General
Historic House/Building
Historic Site
Historical Society

History Museum
Industrial/Transportation
Maritime
Natural History
Science

Institutional Membership Categories
Membership dues are based on your institution's operating budget. Please check the appropriate category:

$75 for up to $50,000
$125 for $50,000 to $100,000
$175 for $100,000 to $250,000
$325 for $250,000 to $500,000
$500 for $500,000 to $1 million
$675 for $1 million to $3 million
$850 for > $3 million

$______ Amount Enclosed

We make mailing labels available occasionally to carefully selected organizations whose services, products or workshops may be of interest. Please check here if you do not wish to have your name released, or call the NEMA office for more information.

Payment by Check made payable to NEMA

Payment by Credit Card (Visa or MasterCard)

Card # ____________________________________________ExpDate_____________________

Signature:__________________________________________________________________

Please complete this form and return to the address below with the appropriate payment.
Questions? Call 781-641-0013.

New England Museum Association
22 Mill Street, Suite 409
Arlington, MA 02476