expERIEnce Children's Museum registration form

Name:

Age:

Address:

City:

State:

Zip:

Phone Number:

Parent/Guardian:

Museum Member:
Yes     No

E-mail Address:

Event You will be attending:

Total

$

Method of Payment   Check Number    Visa Master Card Discover

Number # Expiration Date

Name on Card     Code on back of card



Or

**Your sponsorship donation is tax deductible.

**Please make checks payable to the expERIEnce Children’s Museum.

**Mail this order form to the expERIEnce Children’s Museum, 420 French St., Erie, PA 16507