FRANKLIN PARK CONSERVATORY MEMBERSHIP APPLICATION
1777 East Broad Street | Columbus, OH  43203
Membership Office: 614-645-5617 | Fax: 614-645-5921

Print this page, choose the membership level that is right for you, and provide the information requested then mail
or fax to the Membership department. All membership levels are available as gifts –sent to you or your gift recipient. Please contact the Membership Office at 614-645-5617 or membership@fpconservatory.org with any questions. 

STEP ONE: Choose Your Membership
 


$25 Student

  
$55 Grandparent		  
$250 Patron 
 
$25 Senior Individual		  
$55 Household		  


$500 Benefactor 

 
$30 Individual		  
$85 Supporting 		 
$1000 Cupola 
 
$45 Individual and Guest		  
$100 Centennial 		    

STEP TWO: Member Information (Please PRINT information)

Named Member #1:  Mr. / Mrs. / Ms._______________________________________________ 
(One name only for Student, Senior, Individual and Individual and Guest memberships 

Named Member #2:  Mr. / Mrs. / Ms._______________________________________________
(2nd name for Grandparent, Household and above levels only)                                                                                                        
Address ______________________________________________________________________

City ___________________State_____ ZIP__________       Phone (__ __ __)  __ __ __ - __ __ __ __

E-Mail address ___________________________________________________________________      
(Please provide to receive Conservatory updates and communication regarding your membership.
E-mail addresses are not traded or sold)

For Grandparent, Household and above levels only:
***First names and ages of children or grandchildren who are 18 years old or younger that you want included on this membership MUST BE LISTED BELOW. (use back as needed)***

Child/Grandchild
First Name(s)

Age
(18 & under)

Child/Grandchild
First Name(s)

Age
(18 & under)

Child/Grandchild
First Name(s)

Age
(18 & under)
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STEP THREE: Payment Information    *GIFT GIVER INFORMATION:


Payment Type:
(please select one)
__ Cash            
__ Check (made payable to FPC)
__ Visa        
__ MasterCard    
__ American Express

Card #: ________________________
Ex. Date: ______________________
Signature: ______________________
Name on Card:__________________


Gift Giver Name:________________________
Address________________________________
City _________________  State ___ Zip _____

Gift Giver phone ( _ _ _ )  _ _ _ - _ _ _ _

Send gift membership to:    
__ Gift Giver   __ Recipient

Send renewal notice to:       
__ Gift Giver    __ Recipient