MEMBERSHIPS
Join today and your family can enjoy Exciting Exhibits! Engaging Programs! Thrilling Special Events! Terrific Discounts! all year!
MEMBERSHIPS Explorations V Children’s Museum is a private, non-profit 501(c)(3) organization. All donations are appreciated and tax deductible to the fullest extent allowed by law. Programs sponsored in part by PUBLIX SUPER MARKETS CHARITIES, and the State of Florida, Department of State, Division of Cultural Affairs and the Florida Arts Council, and the National Endowment for the Arts.
109 North Kentucky Avenue, Lakeland, FL 33801-5044 Phone (863) 687-3869 Fax (863) 680-2357 www.explorationsv.com
[email protected] Free Free $7.00 $3.50
Hours: Monday - Saturday 9:00 - 5:30
Daily Admission
Museum Members Children Under 2 Years Children Age 2 - Adult Seniors 65+
Please print legibly & complete all information. Make check payable to Explorations V Children’s Museum and send to
Membership Application
Explorations V Children’s Museum, 109 N. Kentucky Ave., Lakeland, FL 33801 or call (863) 687-3869 for credit card payment.
Adult #1 First & Last Name: __________________________________ Mailing Address: ______________________________________ Telephone: (_______) _______________________
Adult #2 First & Last Name: _______________________________
City: ________________________
State: ______
Zip: ___________
E-Mail Address: ______________________________________________________
Dependant Childrens’ First Name (& Last Name if different) and Birthdates:
Name: _____________________ Birth date: ______________
Name: _____________________ Birth date: ______________
Name: _____________________ Birth date: ______________
Name: _____________________ Birth date: ______________
Name: _____________________ Birth date: ______________
Would you like information on our annual golf tournament? Yes: ____
No: ____
The Museum routinely applies for grants. If you are comfortable doing so, please tell us the following: Ethnic background: African American Annual Income Level:
Asian
Caucasian
Hispanic
Native American
Other
Total # people in household: ____
Under $19,240
Under $25,900
Under $32,560
Under $39,220
Under $45,880
Under $52,540
Under $59,200
Under $65,860
Under $72,520
Under $79,180
Under $85,840
$85,840 or Higher
For Additional Names on your Membership (Grandparent, additional dependant children, sitter, etc.), enter name(s) here ($10 each, not available for 1 on 1 membership). If children, please provide birthday also. ___________________________,
___________________________,
Total Amount Enclosed: $_______________
_____________________________
Signature:____________________
Date:______________
How did you find out about us? Circle one: Friend
Brochure
TV
Family
Phone Book
Newspaper
Flyer/Coupon
Teacher/School
Internet
MUSEUM USE ONLY Effective Date: ______________ Staff Initials: ________________ Total Rec’d: $ _______________ Method (circle one): Cash Charge Check #______ # Cards Issued:______________ Dbase entry date:____________
Memberships are great for Families, Grandparents, and other friends of the Museum! If you’d like to volunteer, call us! A Donated Membership will allow one needy family or community non-profit organization all of the benefits of a membership type of your choice.
Reciprocal admission for select Florida Museums includes FREE admission to: ; Children’s Museum, Inc. - Boca Raton
; Schoolhouse Children’s Museum - Boynton Beach
; Great Explorations - St. Petersburg
; Children’s Museum of the Highlands - Sebring
; Junior Museum of Bay County - Panama City
; My Jewish Discovery Place - Ft. Lauderdale
(Some Membership Types do not apply, refer to table above)
Please present your membership card each time you visit the Museum ($5.00 charge for replacement). All personal information provided is for Museum use only and will not be shared with outside entities. Museum Memberships are non-refundable. For the safety of the children, required adult to child ratio is 1 to 5. Thank you for supporting quality, affordable educational programs for children! Rev. June. 10, 2011