Bedford City/County Museum

Membership / Donation Form

Please mail this completed form and your check to:

Bedford City/County Museum
201 East Main Street
Bedford, VA 24523

Name:

Mailing Address:

City, State & Zip Code

Telephone

E-Mail

Membership Categories

	Special** -- $15.00_____
	Individual -- $25.00_____
	Family/Dual -- $40.00_____

** Students, educators, seniors (over 50)

Donor Levels

	Bronze Donor -- $100+ _____
	Silver Donor -- $250+ _____
	Gold Donor  -- $500+ ____
	Platinum Donor -- $1000+ _____

Memorial Donations

Memorial Gift $_________ 

In Memory of _________________________________________________________

Please send a separate check if also ordering a book.