Use this form to become a member. Please indicate the level of membership, and the amount within that level in which you would like to participate.

Annual Member/Sponsor Levels are available as follows: Mercury   $ 100 to $499 $____________ Gemini   $ 500 to $999 $____________ Apollo   $ 1000 to $4999 $____________ Shuttle   $ 5000 and up $____________ Constellation   $10,000 and up $____________ One time donation $ ______________________ Method of payment:

NAME: __________________________________ (Please Print) ADDRESS: ______________________________ ________________________________________ PHONE: _________________________________ EMAIL: __________________________________ ________________________________________ (SIGNATURE)

Please make check payable to U.S. Space Walk of Fame and mail to:

U.S. SPACE WALK OF FAME
P.O. BOX 6385
TITUSVILLE, FL 32782-6385

We are offering you an opportunity to become a part of our mission by becoming a museum member. This membership entitles you to a 15% discount at the museum’s gift shop located at 4 Main Street , downtown Titusville . You will also get a 10% discount, when you present your membership card, at Dixie Crossroads, Durango’s and Ron Jon’s Surf Shop, with certain limitations at Ron Jon’s. Also, you will be able to enjoy our newsletter and be informed about upcoming events. Best of all, your membership is tax deductible since we are a 501 C(3) non-profit organization (certificate #85-8012741157C-9). We welcome your participation and would encourage you to visit the museum.