Please Indicate Your Selection

Membership Form

Please indicate your selection:

ANNUAL FEE:

MEMBERSHIP

STUDENT □ $40

INDIVIDUAL □ $50

FAMILY □ $100*

SENIOR (65 & over) ______□ $40

PATRON □ $150 & up

Membership entitles you to free gate admission to select special events for the

term of the membership which is one year.

NAME

ADDRESS APT. #

CITY STATE ZIP

E-MAIL___________________________________PHONE_________________

For Family Membership please include first names below.

ADULT 1:

ADULT 2:

CHILDREN (two children under age 18 are included in your family membership):

1.

2._____________________________

ADDITIONAL CHILDREN under age 18…add $15 per child

___________________ _________________ _______________

3 Payment methods:

By E-mail: send this completed form to

after making your payment our website home page:

www.queensfarm.org click DONATE to pay your membership

By Phone: Mon. – Fri. 9:00 a.m. – 5:00 p.m. 718-347-3276 Ext 301

By Mail: send your completed form with a check

payable to: Queens County Farm Museum

73-50 Little Neck Parkway, Floral Park, NY 11004-1129