The Frick Art & Historical Center Membership Enrollment Form
Please print, complete, and return this form to:
Membership Associate
Frick Art & Historical Center
7227 Reynolds Street
Pittsburgh PA 15208
Fax (412) 731-9415
I/we wish to enroll as a member at the indicated level of support for one yearEnrollment Type (circle one): New Renewal
circle one: Mr. Mrs. Miss Ms. Other _______________
Member(s) Full Name (please print clearly):
Children/Ages:
Mailing Address:
City, State, Zip :
Telephone:
Support Level (circle one):
$15 Student (full time) $100 Fellow $30 Senior $250 Patron $45 Individual $500 Benefactor $60 Family/Household* $1000 Founders' Circle
*$60 Family/Household: 2 adults plus all children under the age of 18 living at home.
How did you find out about The Frick Art & Historical Center? (circle one):
web search newspaper radio television friend Greater Pittsburgh Convention and Visitors Bureau other __________________How did you find out about our Web site? (circle one):
web search newspaper radio television friend Greater Pittsburgh Convention and Visitors Bureau other __________________
Additional Options to Support the Frick
__ Send a gift membership at the $________ level to: ________________________
__ Provide an extra unrestricted contribution of $________
__ Corporate Matching Program: If your employer matches contributions, please check with your personnel office to complete the necessary forms.
My employer will match: ________________
Total Payment Enclosed : $__________
Charge my: __ VISA __ Mastercard __ Discover $__________
Credit Card #:_____________________ Expiration Date: __________
Signature: ________________________________________________
Please return this form with your check or credit card number to:
Membership Associate
Frick Art & Historical Center
7227 Reynolds Street
Pittsburgh PA 15208
Fax (412) 731-9415
Under current tax law, all members at the $15, $30, $45, and $60 levels should be entitled to full deductibility for their membership subscription. Donors at the $100 level and above are entitled to a tax deduction to the extent their gift exceeds the fair market value of the membership benefits provided. This information will be provided with our acknowledgement of your gift.
If you have questions, please consult your tax advisor.
If you prefer 100% of your gift be used solely to support The Frick Art & Historical Center's programs, please sign and date.
Signature: ____________________
Date: __________
The Frick Art & Historical Center is registered as a charitable organization. The official registration and financial information may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1-800-732-0999.
Thank you for your membership contribution to The Frick Art & Historical Center.