Print this application out and send it to the address on the form or give it to any Trustee.

MEMBERSHIP APPLICATION

St. Lawrence Power & Equipment Museum, PO Box 400, Madrid, NY 13660

May 17, 2004

Name: ________________________________Check:___ Voting Member ($15/year)

ASSOCIATE MEMBERSHIPS (NON-VOTING):

___ Junior Member – under 18 ($5/year)

___ Business Affiliate ($100/year)

___ Tax Exempt Organization ($25/year)

Address: _______________________________

City: _________________________________ Zip: __________________

Phone: ____________________ Email: _____________________________________

Name of Spouse: ___________________ Does he/she wish to be a member (free)

Check One: ___ Yes ___ No

Please rate your interest in the following from 1 (high) to 5 (low):

____ Flywheel Gas Engines ____ Steam Engines ____ Tractors

____ Farm Equipment ____ Horses/Teams ____ History

Other: ___________________________________________________________________

DATE: _______________