A. Philip Randolph Pullman Porter Museum Membership

To become a member, simply fill out this form and mail it to:

A. Philip Randolp Pullman Porter Museum
Attn: Membership
P.O. Box 6276
Chicago, IL 60628-6276

Or you may fax it to (773) 928-8372

Date:

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Name:

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Address:

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City, State, Zip:

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Phone:

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Membership Categories:
(Contributions to the Museum are tax deductible)

__ $25 Pullman Community Resident
__ $50 General
__ $100 Friend
__ $500 Donor
__ $1,000 Patron

Enclosed is my
check for:

$_______________

-OR- Charge my:

___ AMX
___ VISA
___ MC

Card Number:

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Card Expiration Date:

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Sign Here (if Charge)

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