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Online Membership Form

To purchase a NEW Pennsylvania Academy Membership online, please supply the requested information in the form below and click SUBMIT. You may also RENEW an existing Membership online.

Click here for a printable form.

Membership Information

Membership ID (if available):
Membership Program:	new   renewal
General Membership
	Individual $50
	Family $75
	Friend $150
	Patron $300
	Benefactor $500
Special Interest Membership*
	Student $20
	National $30
	Young Friends $60
	Alumni Circle $100
	Potamkin Collectors Society Members $750
	Young Collectors (under 40 years of age) $350
	* See www.pafa.org/levelsOfMembership.jsp for information on all Special Interest levels of membership.
Charles Willson Peale Society (Please enter the exact amount of your donation)
	Members $1,000 - $2,499
	Mary Cassatt Circle $2,500 - $4,999
	Thomas Eakins Circle $5,000 - $9,999
	President's Circle $10,000 - $24,999
	Chairman's Circle $25,000 and above

Member Information

Title
First Name
Middle Initial
Last Name
Suffix
Address
City
County
State	Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Email Address
Telephone Number (evening)
Telephone Number (daytime)

Additional Membership Information*
*Does not apply to Individual, Young Friends or Student memberships

Name to appear on second Membership Card

If sending a GIFT MEMBERSHIP

Send gift to	Gift Giver Gift Recipient
This is a gift membership for:
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Address
City
State
Zip
Email Address
Telephone Number (evening)
Telephone Number (daytime)
Enter gift message here

Billing Information
Please enter your name exactly as it appears on your credit card.
If your billing information is exactly the same as your Member Information, you may leave this area blank.

Check here if billing information is the same as Member information
Title
First Name
Middle Initial
Suffix
Last Name
Address
City
State	Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Email Address
Telephone Number (evening)
Telephone Number (daytime)

Credit Card Information

Card Type	VISA Mastercard
Card Number
3-digit Security Number	located on the back of your credit card
Expiration Date
Name on Card

Our Mailing List

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The official registration and financial information of the Pennsylvania Academy of the Fine Arts may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.