Membership Application
Please consider creating an account by providing a login and password. This will allow you to manage
your account, view your membership and donation history and get member-only discounts when
purchasing items from the Museum Shop or registering for paid Programs.
Personal Information
Create a Login Name:
Login Password:
Retype Password:
Prefix:
* First Name:
Middle/Initial:
* Last Name:
Birth Date: / /
* Home Address:
* City:
* State:
* Zip Code: -
* Mobile Phone:
Fax:
* Email:
Web Site:

Annual Membership Fees
* Membership: Lucy Burns ($40)
Nina Allender ($75)
Inez Milholland Boissevain ($100)
Alva Belmont ($250)
Alice Paul ($500)
Sewall-Belmont Legacy Committee - Friend's Circle ($1,000)
Sewall-Belmont Legacy Committee - Leadership Circle ($2,500)
Sewall-Belmont Legacy Committee - President's Circle ($5,000)
The membership you have selected will automatically renew.
Please consider an additional contribution to the Sewall-Belmont House & Museum:
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