Membership Registration Form

Online memberships will be processed within 1-2 weeks from online submission date and
gift memberships will be sent priority mail. If you will be visiting the Museum within that time,
please sign up for membership at our box office upon arrival.

This is a:
	New Membership
	Membership Renewal
	Gift Membership *Fill in contact information for person receiving gift membership below
General Information
Adult 1:
Adult 2:
Adult 3:
Children's Names & Birthdates:
Address Line1:
Address Line2:
City:
State:
Zip Code:
Phone #:
E-Mail:
Membership Plan
	Student ($30) - Benefits for one student
	Individual ($40) - Benefits for one individual
	Family ($60) - Benefits for two adults and all children in the household under the age of 18
	Grandparent ($60) - Same as Family membership, but all Grandchildren up to six names.
	Family Plus ($80) - Choose to receive six guest passes OR add a third adult to your Family membership
	Contributor ($250) - All of the above plus an additional FREE half-day Summer Camp Class as well as an invitation for two to a VIP reception
	Donor ($500) - All of the above plus an additional FREE half-day Summer Camp Class and recognition in the Museum galleries
	Benefactor ($1,000) - All of the above pluss an additional FREE half-day Summer Camp Class and lunch with the Museum CEO
Payment Information
Credit Card Type:	Click Here Visa MasterCard American Express
Name on Credit Card:
Credit Card #:
Expiration Date:
Gift Membership Message
Message sent with gift membership:
Automatic Renewal The Miami Science Museum is pleased to announce an automatic membership renewal option. You can now be worry free when it comes to renewing your membership and continue to enjoy uninterrupted benefits year- round.
I authorize the Miami Science Museum to automatically bill the credit card at the current price for my membership renewal on the anniversary of payment.
Yes No