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Membership Application
o Individual $5.00 o Family $7.50 o Supporting $10.00
o Contributing $25.00 o 2 year Contributing $50.00*
o Enclosed is an additional contribution of: $____________________
o apply to general fund
o apply to Duryea Engineering Scholarship
o apply to Artifact Maintenance Fund
o Yes, my contribution qualifies for a matching gift from my employer.
. I have enclosed the matching grant form with my membership application.
TOTAL ENCLOSED________________________ DATE________________________
(Please make checks payable to Peoria Regional Museum Society)
Name ____________________________________
Address ____________________________________
City ____________________________________
Phone _______________________ email ___________________________
(PRMS will not give your email address to anyone)
*Caterpillar Foundation requires a minimum donation of $50.00 annually to qualify for their Matching Gift
program.
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