The Friends of Alice Austen House

The Friends of Alice Austen House Membership Application Form

I am joining at this level: (Please check only one)
	Individual Friend $25
	Family Friend $40
	Individual Senior/Student Friend $15
	Supporting Friend $100
	Business Friend $100 (acknowledged in Viewpoint)
	Sustaining Friend $250 (also receives a copy of the book Alice's World)
	Guardian of Clear Comfort $500 or more(also receives two tickets to Halloween, Holiday, and Father's Day events)

Please enter your information below:
Name:
Address 1:
Address 2:
City:	State: ZIP:
Phone #:	( ) - E-mail:
I would like to make an additional tax-deductable donation of $
Total enclosed: $
Please contact me about volunteer opportunities at the Alice Austen House.

Please print this form and mail it, along with a check or money order, to:

Membership Application
Alice Austen House
2 Hylan Boulevard
Staten Island, NY 10305

Please make all checks payable to:
The Friends of Alice Austen House

Thank you for your support.