Museum Association of New York

Print, Complete &
Mail with fee to:

MANY
265 River St.
Troy, NY 12180

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INSTITUTIONAL MEMBERSHIP JOIN/RENEW

Yes, I am pleased to join/renew our membership and join with other organizations to strengthen and support the museums of New York State. Please make remittance payable to the Museum Association of New York.

My institution's current operating budget is $ ________________________

Membership Fees:

Membership continues for 12 months from the date of renewal.

[ ]	Budget under $50,000:	$55
[ ]	Budget $50,001 - $100,000:	$80
[ ]	Budget $100,001 - $500,000:	$125
[ ]	Budget $500,001 - $1,000,000:	$150
[ ]	Budget $1,000,001 - $2,500,000:	$240
[ ]	Budget $2,500,001 - $5,000,000:	$350
[ ]	Budget over $5,000,000:	$450
[ ]	MANY Institutional Sponsor:	$500

Please complete the following in order that we may update our files:

Name of Director/CEO ___________________________________________

Name & Title of Contact Person ____________________________________

Institution Name _______________________________________________

Mailing Address ________________________________________________

_____________________________________________________________

County ____________________ Telephone ________________ Ext. ______

Fax ___________________ Email _________________________________

Website address ________________________________________________

The following information assists us with advocacy work:

For the most recently completed fiscal year:	# of members	__________
	annual attendance	__________
Chartered by the State Board of Regents?		[ ]Yes [ ]No
Date of Permanent Charter		__________
Congressional District		______
State Senate District		______
State Assembly District		______