GENEX SHOWCASE MINIATURE MUSEUM

MEMBERSHIP FORM

Please select from the following membership levels:

$25.00 Individual	- Listed Benefits -
	-  Designer Charter membership card                -  Frameable Charter certificate                -  Full Free 1 year admission                -  10% off selected merchandise                -  Free Logo T-shirt                -  Free museum library privileges
$50.00 Family	- All listed benefits including 2 adults and 2 children admission tickets plus 4 Logo "T" shirts - Add $5.00 for each additional child.
$100.00 Sustaining	- All listed benefits plus - Beautiful charter member plaque plus - Advance event notices
$250.00 Silver	- All listed benefits plus - Beautiful Charter member plaque plus - Advance event notices
$500.00 Gold	-All listed benefits (with 5 passes) plus - Beautiful recognition trophy plus - Name inscribed on charter member plaque plus - Limited Edition collectible ($50.00 value)
$1000.00 Platinum	- All listed benefits (with 10 passes) plus - Beautiful recognition trophy plus - Name inscribed on charter member plaque plus - Limited Edition collectible ($100.00 value)
$1000.00+ Connoisseur	- All listed benefits (with 20 passes) plus - Beautiful recognition trophy plus - Name inscribed on charter member plaque plus - Invitation to sponsor exhibitions
To subscribe please fill in the form below and send with your check or money order to: GENEX SHOWCASE MINIATURE MUSEUM 11712 JEFFERSON AVE., SUITE C527 NEWPORT NEWS, VA 23606-4406

Name: Dr./Mr./Mrs./Ms.: ___________________________________________

Address:__________________________________________________________

City: __________________________ State: ___________ Zip: __________

Telephone Number (with area code): ______________________________

E-mail address: _______________________________________________

Choice of Membership level____________________________ $________

Remittance in the form of: Personal Check Certified Check Money Order