Duo $75 Membership Form Includes all Standard Membership benefits Purchaser Information: for one individual and one guest Name:______Group $125 Standard Membership Benefits to the Buddy Includes all Standard Membership benefits Address:______Holly Center for two adults and up to two children (ages

7-17) Engraved Courtyard Brick ($125.00 City/State:______The following benefits are available to value)- placed permanently in the BHC Members at all levels for one year. Benefits Meadows Courtyard. Bricks are one time Zip code:______are subject to change. only; bricks are not given on membership

renewals. Work Phone:______ Free admission for one year to the

Buddy Holly Center exhibitions Individual- Municipal Museums Joint Home/Cell Phone:______ 10% discount on select merchandise Membership $80 in the Museum gift shop Includes all Standard Membership benefits Email Address:______ Discounts on Museum camps, for one individual at both the Buddy Holly classes and programs Center & Silent Wings Museum ______ Invitation to member-only events such as receptions, previews, and Group- Municipal Museums Joint Membership Level:______Museum gift shop specials Membership $230  Subscription to the Museum's Includes all Standard Membership benefits Tee Shirt Size:______member e-newsletter for two adults and up to two children (ages  Personalized membership card Payment: 7-17) at both the Buddy Holly Center &  Buddy Holly Center Member’s Only Make your check payable to The Buddy Holly Silent Wings Museum. Engraved Courtyard decal and one Buddy Holly Center Center or charge the fee to: Brick ($125.00 value)- placed permanently in Members Only T-Shirt the location of your choice- The BHC Card No.______Student $20 (w/Student ID) Meadows Courtyard or The SWM Patriot Includes all Standard Membership benefits Plaza. Bricks are one time only; bricks are Exp. Date______for one individual not given on membership renewals. Amount to Charge______Additional bricks can be purchased for Individual $50 $125.00 Includes all Standard Membership benefits Authorized Signature for one individual ______

TM Maria Elena Holly BHC Meadows Courtyard Engraved Brick or Tile

Brick (4”x8”) $125 Tile (8”x8”) $500

Name: Please print name(s) as you would like it to appear. You are allowed 2 lines with up to 14 characters per line.

Or check here if you would like to dedicate your brick in memory or honor of someone:

In memory of:

In honor of:

Your name:

Address:

Phone: Fax: Email:

Payment Method: (please circle one of the following)

Check or Charge to card type: ______Amount: ______$125 ______$500

Account Number Expiration

Date Signature