Museum Membership Form

Please complete the information below, print the page and mail it to:
Sandra K. Davis RN, Ed.D
Museum of Nursing History, Inc.
761 Sproul Road, #299
Springfield, PA 19064

Student or Retired ($15)
Individual ($35)
Organization/Agency ($100)
Patron ($150)
Life Member ($500)
Additional gift of

Name:
Address:
Telephone: e-mail:

Your contribution to the Museum of Nursing History is tax deductible.

I am interested in participating in the museum's activities.
exhibits/acquisitions/cataloguing
education/programs
membership
newsletter/Web page
PR & Fundraising