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1500 East Garrison Blvd.
Gastonia, NC 28054
P 704-866-6900
F 704-866-6041
Membership Application
Complete the form below to become a new Member or to renew your membership. Fields marked with an asterisk (*) are required.
New or Renewing Membership
Is this a new membership or are you renewing your membership?
New Membership Renewing Membership
Member Information
Membership cards can list up to two names.
First Name 1*
Last Name 1*
First Name 2
Last Name 2
Address 1*
Address 2
City*
State*
Zip Code* -
Telephone* - -
Your e-mail is required to receive e-news and other Museum communications. It will never be shared with a third party.
E-mail*
Membership Level
Please select the level at which you would like to join or renew.
  Individual - $50
  Family - $75
  Benefactor - $250
Schiele Society - $500+ Guardian - $2,000
Children in Household
Please enter up to three names and birthdates below.
Name Birthdate
Name Birthdate
Name Birthdate
Gift Membership
Is this a gift membership?
Yes No
Would you like us to ship membership information to recipient?
Yes No
Recipient's First Name*
Recipient's Last Name*
Recipient's Address 1*
Recipient's Address 2
Recipient's City*
Recipient's State*
Recipient's Zip Code* -
Recipient's Telephone* - -
Recipient's E-mail*
Special Instructions
Payment
Please select your method of payment.
Visa Mastercard
Card Number*
Card Expiration Date*
Help Us Plan Our Programs!
Please check all ages of adults in your household.
Under 24 25-35 36-54
55-64 65+
Please check all ages of children in your household.
None 1-6
7-12 13-18
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