Section of an image of a bridge
New York State Archives
Partnership Trust
Preserving the Past for the Future
Become a Member:

Archives Partnership Trust
Membership Application Form

Yes! I want to join (or renew my membership in) the Archives Partnership Trust.

Yes! I want to give a gift membership to the Archives Partnership Trust.

Yes! I want to both join (or renew my membership in) the Archives Partnership Trust AND give a gift membership.


My information:

Name:
___________________________________________
Address:
___________________________________________
City:
___________________________________________
State:
___________________________________________
Zip:
___________________________________________
Phone (Day):
___________________________________________
Phone (Evening):
___________________________________________
Email
___________________________________________

  Membership Levels
One Year
Two Years
  Friend/Family
 
$35
 
$65
  Senior Citizen/Student
 
$25
$45
  Supporter
 
$100
$180
           


Please send a gift membership to:

Name:
___________________________________________
Address:
___________________________________________
City:
___________________________________________
State:
___________________________________________
Zip:
___________________________________________
Phone (Day):
___________________________________________
Phone (Evening):
___________________________________________
Email
___________________________________________
This gift is:
for a birthday
for a marriage
in honor of
other (please specify):___________________
 
  Gift Membership Level
One Year
Two Years
  Friend/Family
$35

$65
  Senior Citizen/Student
$25

$45
  Supporter
$100
$180

I would like the gift card signed:

________________________________________
Renewal Notice: The renewal notice for the gift membership should be sent to:
me my gift recipient.

Payment Information:

Membership Fee(s) $______________
Annual Appeal: (Optional) Please accept my unrestricted contribution. $______________
TOTAL $______________

Enclosed is a check made payable to the Archives Partnership Trust.

Please charge my: Visa MasterCard Discover AMEX

ACCOUNT NUMBER:
________________________________
EXPIRATION DATE:
________________________________
CVV # (last 3 digits on card's signature line or, for AmEx, the 4 digits above card # ):
________________________________
SIGNATURE:
________________________________

Occasionally we share our mailing list with other non-profit cultural organizations. If you prefer not to receive such mailings, please check the box.

Print and mail this form to: Or fax form to:
Archives Partnership Trust
Cultural Education Center, Suite 9C49
Albany, NY 12230		 518-473-7058