MEMBERSHIP REGISTRATION Please print and complete this form, then mail it to: The Lyceum Company Attn: Membership 201 South Washington Street Alexandria, Va. 22314

TYPE OF MEMBERSHIP   Individual ($20) Patron ($100) Family/Couple ($30) Sponsor ($500)   Benefactor ($1,000)   New Member Renewal Member

CONTACT INFORMATION Name(s):   Address:     Home Phone:   Work Phone:

PAYMENT Enclosed is a check payable to The Lyceum Company in the amount of   $ . Please charge my VISA MasterCard American Express Card # Expiration Signature:

ADDITIONAL INFORMATION I may also be able to help The Lyceum Company in the following ways:   Volunteer work in the museum Board service Helping with special events Artifact acquisition

THANK YOU FOR SUPPORTING ALEXANDRIA’S HISTORY