Gift Membership Form
Please print and fill out this form. When completed, please fax or mail the form to:
Duluth Children's Museum
506 West Michigan Street
Duluth, MN 55802
(Fax) 218-733-7547

Date: _________________

Gift Recipient Information

Cardholder 1:  ___________________________________________

Cardholder 2:  ___________________________________________

Child: _________________________Birthday (mo/yr): ____/____

Child: _________________________Birthday (mo/yr): ____/____

Child: _________________________Birthday (mo/yr): ____/____
Please list additional children, along with ages and birthday on back.

Address: _______________________________________________

City, St, Zip: _________________________________________________

Phone(s): _____________________ Email: ________________________

Gift Membership Type: Household/Family   Grandparent/Grandchild

Gift Membership Level (check one of the following):
Discovery Passport ($130)
Discovery Plus ($115): choose one Children's Museums Science Centers
Discovery($55)

Payment Options

Amount Enclosed: $___________ 

Check                          Check Number: ______________

VISA               MasterCard

Card Number: __________________________ Expires: __________

Signature: ______________________________________________

Gift Giver Information

Name:__________________________________________________

Address: _______________________________________________ 

City, State, Zip: _______________________________________________

Phone(s): ______________________ Email: _______________________

Send membership cards and information to: Gift Giver   Gift Recipient

Add me to your mailing list: Yes   No


For office use only:

DateRcv: _________  RenDate: _________ Ref#:________ Amt: __________ TY:

Thank you for your membership.  If you have any questions, please call 218-733-7543.