MACC Membership Application Form

Institution: ____________________________________________________________________

Contact Person/Title: ____________________________________________________________

Address: _____________________________________________________________________

Address: _____________________________________________________________________

City/State/Zip Code: _____________________________________________________________

Phone: ( ______ ) __________________________    Fax: ( ______ ) _______________________

E-mail: _____________________________    Website: _________________________________

Membership Level (please circle one):

If your annual budget is:

General Membership cost is:

Up to $ 100,000

$ 50

$ 100,000 to $ 500,000

$ 100

$ 500,000 to $ 1,000,000

$ 200

$ 1,000,000 to $ 5,000,000

$ 300
$ 5,000,000 to $10,000,000
$ 400
$ 10,000,000+
$ 600

Checks Payable to MACC, or include VISA/MC number, exp.date, cardholder name and address. Please mail this application, membership dues payable to MACC and documentation demonstrating that your organization is a 501(c)(3), 509(a)(1), or a 509(a)(2) to:

Midwest Art Conservation Center • 2400 3rd Avenue South • Minneapolis, MN 55404

Membership renewal notices will be sent on the anniversary of your membership. Dues must be received before organization is eligible for membership benefits. If you have any questions, please contact us at (612) 870-3120. Office hours are 8:30 am to 5:00 pm, Monday-Friday.