Goudreau Museum Membership Registration

Please print and complete this form, 
then send it along with your membership dues to:


Goudreau Museum of Mathematics in Art and Science
Herricks Community Center
999 Herricks Road, Room 202
New Hyde Park, NY  11040-1353

YES!  I'd like to join as a member and support the Goudreau Museum of Mathematics and receive all the benefits and privileges of membership.

Category of membership:
[    ] Individual: $25 [    ] Family: $35 [    ] Patron: $50
[    ] Educational Institution: $75 [    ] Student (K-12): $15  Grade:___
[    ] Donor: $100 [    ] Corporate: $250


Name_______________________________________________

For family membership include names of family members.  Please indicate grade level(s)/age(s)  of child(ren)
____________________________________________________

__________________________________________________________

Address ________________________________________

__________________________________Zip___________

Phone (____)_____________________________________

E-Mail__________________@_______________________

Total enclosed: ___________

Please make checks payable to Goudreau Museum.
For further information, call 516-747-0777
or send an e-mail message, info@mathmuseum.org
Learn about the benefits of
membership by clicking here

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This page last updated 6/25/03