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2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip*
11. Phone*
12. Email*
14. Membership Level*

    1. Individual - $25
    2. Student / Senior - $10
    3. Family - $40
    4. Supporting - $50 to $99
    5. Contributing - $100 to $499
    6. Sustaining - $500 to $1000
    7. Corporate - $1000+
15. Benefits include:
    • FREE ADMISSION to the Rockpile Museum
    • 10% discount at the museum gift shop for all members
    • Quarterly newsletter
    • Advance notification of all Rockpile Museum events
    • First choice for limited attendance events
    • The satisfaction of supporting your community museum

17. Please make check payable to the Rockpile Museum Association. Submit and print out this form when completed and return the completed application to:

    Rockpile Museum Association
    Attn: Memberships
    900 W. Second St.
    Gillette, WY 82716

    
    

    The Rockpile Museum Association is a 501(c)(3) organization.

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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

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