The Blair Museum of Lithophanes

Museum Friends Membership Application

Name___________________________________________________________________

Mailing Address__________________________________________________________

City________________________ State_________ Country____________ Zip________

Phone______________________ Fax ___________________ email________________

Yes, I would like to become a Friend of the Blair Museum of Lithophanes at the following membership level:

_____Patron and Corporate sponsor $10,000

_____Benefactor $1000

_____Supporting $500

_____Business $250

_____Lifetime $200

_____Contributing $125

_____Family $50

_____Individual $35

_____Student and Senior Citizen $25

Checks should be made payable to: The Blair Museum of Lithophanes

Please mail your tax deductible contribution to:

The Blair Museum of Lithophanes

Membership Office

5403 Elmer Drive

Toledo, OH 43615 USA

For more information email curator@lithophanemuseum.org or phone 419-245-1356 or visit our website at www.lithophanemuseum.org

Please send more information about the Blair Museum of Lithophanes_____