Membership Form

Need the perfect gift for a friend or family member?

Share the Sciencenter with others by gifting them a membership!

This form is for gift memberships only. To purchase a membership for yourself, please click here.

Membership Option

Choose a Level

Recipient Information

Please list one or two adults in the household that will be the primary members on the gift membership. These are the names that will appear on their membership card.

Primary Adult Member Name

Second Adult Member Name

Gift Recipient Address

Gift Recipient Address 2

Gift Recipient City

Gift Recipient State

Gift Recipient Zip Code

Gift Recipient Email

Gift Recipient Phone Number

Purchaser Information

Tell us about yourself.

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Gift Membership Delivery Option

Who should we say this gift is from?

Where should we email the gift membership to?

Email directly to the recipient.Email to me, the purchaser - I want to send it!

* Where should we email the gift membership to? is required.

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment. PCI Compliance.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.