Name_________________________________________________________

Address______________________________________________________

City, State__________________________________________________

Telephone (Optional)_________________________________________

Email (Optional)_____________________________________________

Donor - $1 and Up []       
Sustaining - $50 and up [] 
Contributing - $100 and up []     
Supporting - $500 and up []      
Benefactor - $1000 and up []

Do you wish to remain anonymous?   Yes []    No []

Send your tax deductible donations to:

Allegheny Musarium Assoc.
P. O. Box 554
Warren, PA  16365

Thank you.